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https://forms.lumc.nl/lumc2/VA-Authorisation_PhotoVideo_Recordings
Authorisation form for photo- and video recordings
Master Health, Ageing and Society
Based on the following conditions, the undersigned has no objections to publicise photo- or movie recordings for the promotion of the Master Health, Ageing & Society
The photo- or movie recordings will be used for promotion purposes on the website and social media (such as Linked-In and Instagram) of the Master Health, Ageing & Society;
The photo- or movie recordings will be used for flyer or other promotion material;
The undersigned hereby declares to give permission for publishing the photo or movie recordings material.
The recording material will, without permission of the undersigned, not be used for other purposes than previously described.
Agreement
Declaration:
I certify that I have read and understand the foregoing information and agree to be bound by it.
Surname
Initials
First name
Student number
Enter only
7
digits
Email adress
Leiden,
dd/mm/yyyy
Albinusdreef 2, Postbus 9600, 2300 RC Leiden |
Albinusdreef 2, P.O.box 9600, 2300 RC Leiden
ACAD-062016-Sijtsema-MJ