Inception Strategies Recording Consent

Name *

First Name

Last Name

I hereby consent to allow Inception Strategies to record me talking about smoking, Aboriginal culture, my experiences and authorise Inception Strategies & Apunipima to use this recording to create a community voices booklet about Tackling Indigenous Smoking to be used by Aboriginal people in Far North QLD. *

Yes

No

I am happy for my photo to be used by an artist to draw my likeness so I can appear in the booklet *

Yes

No