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Media Consent Form

From time to time, as part of our ongoing PR and fundraising activities, we may wish to use your story and/or images that feature you. Please could you complete the form below to indicate which outlets or channels you are happy for us to utilise.

  • Please tick to confirm which channels you are happy for us to use your story and/or images. Leave blank if you would prefer us not to use on that channel.

  • This field is for validation purposes and should be left unchanged.
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