Consent Form for Disclosure of Information

You may have decided to support our work by, for example, organising an event, giving a talk or doing a sponsored walk or run, or you may be a patient who has decided to share their experience of being diagnosed and treated for a gynaecological cancer.

We would like to use your story to help with our marketing, fundraising and awareness campaigns. We use only information which you have approved and only in the ways you have indicated on this form.

Please tick all the ways in which you consent to your information being used and provide your contact details.

Effect of signing the form:

  1. You consent to GRACE using, in the ways you have indicated on the form, information you have approved and information in the public domain (for example, on websites and social media) for marketing, publicity, fundraising and awareness campaigns.
  2. You acknowledge that GRACE is not liable for information used by third parties (for example, information we supply to the media) in circumstances where the use of the information is outside the control of GRACE.

Consent Form

Please tick all the ways in which you consent to your information being used.