Photographic and Media Consent

Information

I hereby consent to the collection and use of my personal images by photography or video recording.

I acknowledge these may be used on The Little Black Duck website, in newsletters and publications as well as distributed to members.

I further acknowledge that my image may be used by The Little Black Duck and media to promote The Little Black Duck in the future.

I understand that no personal information, such as names, will be used in any publications unless express consent is given.

I also understand that my consent can be withdrawn at anytime in writing to The Little Black Duck at

108 Colman St, Wodonga, Vic, 3690

0407 056 442

melanie@thelittleblackduck.com.au

www.thelittleblackduck.com.au

www.facebook.com/alittleblackduck