Media Release Form

Full Name

Email Address

Organisation

Do you consent to Accountants Therapy recording and using your participation (voice, image, name, and/or contributions) in the following types of media? Do you consent to Accountants Therapy recording and using your participation (voice, image, name, and/or contributions) in the following types of media? Group discussions (live or recorded), webinars, workshops, and training events, online meetings (e.g. Zoom sessions), in-person events, social media, website, and email newsletters, educational or promotional content Yes, I give consent to all of the above No, I do not consent to any media use

Do you understand that any recordings, photos, or materials created remain the property of Accoutants Therapy and may be edited, shared, or published without further approval or compensation? Do you understand that any recordings, photos, or materials created remain the property of Accoutants Therapy and may be edited, shared, or published without further approval or compensation? Yes, I understand and agree No, I do not agree

If you wish to place limitations on your participation, please indicate below: If you wish to place limitations on your participation, please indicate below: I do not consent to video/audio recording I consent but do not want to be named in any published materials I would prefer to remain off camera No limitations – I am happy to participate fully Other limitations (please specify below)

Other, please specify

By submitting this form, you confirm that you have read and understood Accountants Therapy’s Media Participation Release and voluntarily agree to its terms. By submitting this form, you confirm that you have read and understood Accountants Therapy’s Media Participation Release and voluntarily agree to its terms. Yes, I agree No, I do not agree

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Date of Agreement