Media Interview Consent Form

Please read the form carefully, complete the required fields.

Participant Information

Consent Agreement

I, [Your Name], hereby grant permission to [Your Company Name] to record, photograph, and/or interview me for media purposes. I understand that my statements, likeness, and recordings may be used in promotional materials, social media, websites, or other media platforms associated with [Your Company Name].

I confirm that I am voluntarily participating and understand that I will not receive compensation for the use of these materials. I may withdraw my consent at any time by notifying [Your Company Name] in writing.

Name:

Date:

Form Templates @ Template.net

Thank you for your support!

We appreciate you taking the time to submit.

Create free forms at Template.net