Consent Form

DUO Visual Media Photography & Video Permission Form

I grant permission to DUO Visual Media, its representatives and employees the right to take photographs and videos of me and my property. I authorise DUO Visual Media, its assignees and transferees to copyright, use and publish the same in print/TV/and/or electronically. I agree thatDUO Visual Media may use such photographs/videos of with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising and web content.

I have read and understand the above:

Date

YYYY

Name

First Name

Last Name

Office Email

Office Phone

(###)

###

####

Do you consent to the above statement?