LPC Awards 2025 Media Consent Form - Coalition for Personalised Care

the nominee

The event at the Governors Hall, London. We will streamed live on the 1st of December 2025, we will also be taking photographs of the event. This form states how we intend to use the footage to promote the Awards and Integrated Personalised Care.

Your Details

Your Name:

First

Last

Email:

Confirm Email

Telephone number:

If you are not the nominee, please tell us the name of the nominee you are accompanying or representing:

Agreement

I agree to the following:

By signing this form, you are confirming that you agree to appear in the live streaming of the London Personalised Care Awards 2025 Awards Event on the 1st of December 2025 including videos and photographs.
By signing this form, you are confirming that you agree to have your story used in one or more of the following ways: a Coalition for Personalised Care/NHS publication, website or social media channel (such as South West IPC/Coalition for Personalised Care /NHSEI Facebook, LinkedIn, Bluesky or You Tube page), or for an external media organisation (such as a newspaper, radio station, TV company).
By signing this form, you understand that your story could be used in the following format(s): Video, Audio, Social Media Posts (Bluesky, LinkedIn, etc.), Photographs, Written or other.
By signing this form, you also understand that South West IPC has no control over the future use of materials by external/media organisations.