Media consent form

1. I give my permission to you, Royal National Institute of Blind People (RNIB), to use my stories, quotes, and photographs/video film/audio. I hereby grant RNIB and any third party assignees or licensees the absolute right to use the stories, quotes, audio and images resulting from the interviews and photography/video shoots, and any reproductions or adaptations of the images for any purposes in relation to RNIB’s work including, without limitation, the right to use them in any advertisements and other publicity materials, direct mail, books, newspapers, magazine articles, television programmes and internet publications to promote and raise awareness of RNIB and its work.
2. I understand that I do not own copyright or have any rights of ownership or other claim over the images.
3. I understand that RNIB will keep all the images and story content and use them for an indefinite period, but that I can withdraw my consent in writing at any time – this can be done by emailing [email protected] or writing to Stories Library, The Grimaldi Building, 154a Pentonville Road, London, N1 9JE .

While we have taken care to ensure this form is accessible, please get in touch if you have any problems completing it. Alternatively, screen reader users might find the word version linked below more accessible. Please return completed forms to [email protected]. If you have any other queries, or wish to speak to someone at RNIB before completing the form, please call or message us on 07753 100205 or email [email protected].

Click here for the Word version of the form.