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LOCAL BUSINESS CONSENT FORMMoira Shire Council is seeking your permission to collect and publish, publically available photographs, data or any other information supplied by you, relating to the structure, operations and any current/proposed projects to be undertaken by your business, to both promote your company and to advertise the advantages of investing in Moira Shire.
This information may be used for publication in the BUSINESS Investment Opportunities section of our website, the Business in Moira Facebook page, other official Moira Shire Council website and social media mediums, as well as our e-newsletter, and/or The Economic Development business prospectus and Business Register.
Please fill in the relevant fields below then email signed form to [email protected]
Business / Trading Name Click or tap here to enter text.
Business Address Click or tap here to enter text.
Postal Address Click or tap here to enter text.
CONTACT PERSON
Name Click or tap here to enter text. Job Title Click or tap here to enter text.
Email Click or tap here to enter text. Phone / Mobile # Click or tap here to enter text.
BUSINESS CATEGORY – Choose an item.
Products or Services supplied Click or tap here to enter text.
WEBSITE Click or tap here to enter text. SOCIAL MEDIA Click or tap here to enter text.
PERMISSION TO DISTRIBUTE ON
WEBSITE – Business WEBSITE – Moira Shire
SOCIAL MEDIA E-NEWSLETTER BUSINESS REGISTER PROSPECTUS AUTHORISATION
I hereby agree to the terms and understand the conditions set out below.
Signed Name
Date Click or tap to enter a date.
GRANTING OF A NON-EXCLUSIVE LICENCE AND CONDITIONSBy signing this form, you are granting a non-exclusive licence to Moira Shire’s Economic Development Branch (upon approval of proposed publication by you) to copy or reproduce such material (whether by photo, film or other electronic or printed material) as Moira Shire’s Economic Development Branch may determine without the entitlement to any remuneration of compensation for moral rights and copyright now or in the future.Moira Shire’s Economic Development Branch agrees not to use any photo or other data in a manner that may be deemed adverse, or defamatory to the person and by extension the company they represent signing this form.