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CONSENT TO DISCLOSE PERSONAL INFORMATION

Pursuant to Section 33.1(1)(b) of the British Columbia Freedom of Information and Protection of Privacy Act (RSBC 1996, c. 165), I give my consent to Simon Fraser University to disclose my personal information under the conditions noted below.

* Indicates a required field.

First Name

Last Name

Email Address

Reason for Submission Please specify if this submission is for a course, for research purposes, or specify otherwise. If this submission is for a course, please include the course number (e.g., EVSC 100).

Supervisor or Instructor If this submission is for a course, please enter the name of the course instructor; if this submission is for research, please enter the name of the Principle Investigator (PI).

Telephone Number (optional)

Personal information disseminated in SFU printed materials, website and/or social media channels will be used exclusively for non-commercial marketing and promotions purposes. Graphic and audible depiction - photographs and video content Contact information (e-mail address only) Information provided in the text box below (please cut-and-paste the information that you consent to disclose)

Consent to use of personal information in SFU printed materials By checking this box, I hereby give my consent

Consent to use of personal information on the SFU website By checking this box, I hereby give my consent

Consent to use of personal information on SFU social media By checking this box, I hereby give my consent

Date of Consent

I am of legal age and have the right to contract in my own name. I have read the foregoing and fully understand the contents thereof. This release shall be binding upon me and my heirs, legal representatives and assigns. By pressing the "I Accept" button below, I am consenting to a non-expiratory disclosure of my personal information (as outlined above).

If you would like to specify the date on which the consent expires, you should press "I DO NOT Accept" button and send an email to sesgrad@sfu.ca after filling out the PDF form.

School of Environmental Science

CONSENT TO DISCLOSE PERSONAL INFORMATION

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