Declaration of Consent to the Publication of Photos, Videos and Audio

Name

First Name

Date of Birth

Project/Event

Terms and Conditions for Copying, Distribution and Modification of Photos, Videos
and Audio Files

I hereby declare for good and valuable consideration, that my photos, videos and audios can be used,
modified and published by Ingenieure ohne Grenzen e.V. free from limitations of time, place and facts
for any PR- and Fundraising-related use in online as well as printed media. The use may include, but is
not limited to, editing, du plication, licensing, distribution and incorporation in other works, in
whatever form (e.g. hard copy or electronic), such as posters, publications, web sites, films or videos,
and their unrestricted use, without any obligation on the part of Engineers without Borders to seek
any further authorization by the undersigned.
I consent to the use of my name in connection with the photographs, videos and audios:

[YES] / [NO]

Your declaration of Consent to Publication of Photo s, Videos and Audios remains voluntary
and can be revoked. Your revocation becomes effective with the date of the announcement.
I declare being a major and that I have the full right to make this declaration of consent. In the event
that I am a minor, this declaration of consent will be made by the entitled parent or

Place, Date Signature