Nonprofit Campaign Filming Consent
Provide your consent to be filmed and participate in our nonprofit campaign.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Organization or Affiliation (if any)
Your Role in the Campaign
Please Select
Participant
Volunteer
Staff
Speaker
Other
Campaign/Event Name
*
Date of Filming
*
-
Month
-
Day
Year
Date
Location of Filming
*
Emergency Contact Name
Emergency Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Signature
*
Submit Consent
Submit Consent
Should be Empty: