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CONSENT FORM FOR INDIVIDUALS TO BE RECORDED, FILMED OR PHOTOGRAPHED

To: Nesta
58 Victoria Embankment, London EC4Y 0DS
Registered as a charity in England and Wales 1144091 and Scotland SC042833

Project: Public AI Task Force

Please sign below to confirm the following:

● I agree that my image or my contribution may be included in the video, podcast, publication or other material identified above. I understand that my image or contribution may be edited and there is no guarantee it will be used. I will not seek any payment in return for my image or contribution.

● I agree that my image and contribution (or part of it) may be used to publicise this project, Nesta and its work generally and may be distributed in any media and for any purpose anywhere in the world.

● Where my contribution has been filmed or recorded, I confirm that I have been truthful and honest to the best of my knowledge and have not deliberately concealed any relevant facts from the makers of the film or recording.

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June 6, 2025 4:52 pm BST

Nesta - Public AI Task Force - Consent Form Uploaded by Georgie Chaffey - [email protected] IP 82.148.32.25

June 6, 2025 5:00 pm BST

Take Part - [email protected] added by Georgie Chaffey - [email protected] as a CC'd Recipient Ip: 82.148.32.25