Media Consent Form

The Schizophrenia Fellowship of NSW aims to ensure you are fully aware and understand the reasons for the sharing of personal information in media publications and the need for us to gain your consent.

Please note, even after submitting this form, you are free to withdraw your consent at any time prior to the finalisation of the media material to be published.

Fill in the form below     OR    download the Media Consent Form (PDF 127.4KB)

Please ask a member of staff if you have any difficulties understanding this form.

Schizophrenia Fellowship of New South Wales Inc
Building 36 Digby Road, Old Gladesville Hospital, Gladesville  NSW 2111
Locked Bag 5014, Gladesville  NSW 1675
T: 02 9879 2600    F: 02 9879 2699
E: admin@sfnsw.org.au    W: www.sfnsw.org.au

Media Consent

I hereby grant permission to Schizophrenia Fellowship of NSW Inc. (SFNSW) to use my name, likeness and/or voice, or the name, likeness and/or voice of my minor child for all publicity purposes and in any media format. Media formats include, but are not limited to: newspapers, magazines, television, radio, film, or on the Internet. I understand that I will not be paid or rewarded for providing this authorisation. SFNSW shall retain all rights to said materials.

Mandatory field(s) marked with *