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JakeMayhewMedia Email: jakemayhew43@gmail.

com Tel:
07443506881

Release Consent Form


[interviewee]

Full name:

Date of birth:
........
.......

Profession/Education:

Location of work/education:

Contact address [i.e phone number, email]:

By signing this form I declare that I give full


consent to be a part of and shown in the
amateur video project Deadly Inhales.

Signature of interviewee:
...
JakeMayhewMedia Email: jakemayhew43@gmail.com Tel:
07443506881

Date:..

Signature of Interviewer/Film Producer:


..

Date:

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