Journalistic Recording Consent Form
Please complete this Journalistic Recording Consent Form to authorize the recording and use of your statements for journalistic purposes.
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
Type of recording
*
Audio
Video
Photography
Other
Purpose of recording
*
Date of consent
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Location of recording
Signature
*
Submit Consent
Submit Consent
Should be Empty: