Image Consent Statement For An Adult
I, _____________________________________________________, consent to the use of my image for the legitimate purposes stated below:
- My image may be used, reproduced, and published for promotional, educational, and/or informational purposes related to the activities of The World Academy of Sciences for the advancement of science in developing countries (UNESCO-TWAS) and the the Conrado Wessel Foundation (FCW) (the Organizations) for an unlimited period of time, throughout the world, including in accordance with the UNESCO’s Open Access (OA) Policy and open licensing terms.
- My image may be used on the Organizations’ website, social media accounts, in photographs or videos, in printed materials, or in other media (collectively referred to as “content”) as determined by the Organizations.
I acknowledge that I have no right to inspect or approve the finished product or the use to which my image may be applied. I acknowledge that I will not receive any financial or other type of compensation arising from or related to the use of my image.
Regardless, I understand that I retain ownership of my image within the content. My image is my likeness and is a personal attribute that remains my own.
I may revoke my consent at any time for future use or distribution of my image by the Organizations by providing written notice. I also have right to access and request correction of any personal data held by the Organizations. To exercise my rights in connection with this statement, I can contact pio@twas.org. For any other questions regarding the processing of personal data, I can contact privacy@unesco.org.
I acknowledge that the Organizations are not responsible for any unauthorized use of my image by third parties.
I am the subject and I acknowledge that I have read and fully understand this consent statement, and that I am signing it voluntarily and without any coercion or pressure from the Organizations or its representatives.
| Signed: |
| Date: |
| Address and/or Email of subject: |
| TO BE FILLED IN BY THE PHOTOGRAPHER: |
| Date of the photograph: |
| Location: |