Pubblication authorization

Name:

Surname:

Birth date:

I AUTHORIZE:

the publication of images/videos depicting my tattoos, and / or more generally my person, taken by the tattoo artist Sara Liverani (tax code: LVRSRA85C62D705C);

PROHIBITING its use in contests that affect my personal dignity and decorum

ALLOWING the registration by any means, reproduction on any known and future technical and / or multimedia support and dissemination on any web platform (and in particular the blog and the website of the tattoo artist), for an unlimited time.

ALLOWING the printing and publication in magazines, books, brochures and in promotional material of the tattoo artist, display and projection at seminars, exhibitions, debates, conferences, as well as use by the tattoo artist for events / future works.

The stories, written or oral, that talk about my personal life stories should not contain
clear references cthat make my person unequivocally recognizable, but they must make the story possibly valid for many people.
I acknowledge in any case that my person may still be recognizable to third parties, being able to connect the tattoo / drawing depicted to my story, and vice versa.

(choose one, none or all of the options you want to authorize)

I consent to the partial publication of the interview I gave and the life experiences I told to the aforementioned person for educational and formative communication purposes;I consent to the disclosure of information that was a source of inspiration for the creation of the tattoo design performed by Sara Liverani and depicted in the video / photographic footage released today or in oral or written interviews released in the past, for educational and formative communication purposes ;

(choose which of the two options you prefer)

The publication and reproduction can take place in NON-ANONYMOUS form, eventually publishing my generic nameThe publication and reproduction must take place exclusively in ANONYMOUS form and / or with the use of pseudonyms, without total reproduction of my face (except that this is the part of the body tattooed).

Do you want to be tagged in the photos that I will eventually post on Instagram?YesNo

To the extent necessary, I declare that this authorization is valid pursuant to art. 97 of the
Italian law on copyright (law n. 633 of 22 April 1943).

I declare to take full responsibility for the declarations made,, relieving the tattoo artist Sara Liverani of any claim and action even of third parties, and to be informed of any download, interviews, stories and images.
The use of recordings,, images and the narration narrated by me are to be considered free of charge..

location:

Signature:

PRIVACY POLICY

To the extent necessary, I declare that this authorization is valid pursuant to art. 97 of the Italian law on copyright (law n. 633 of 22 April 1943). I declare to take full responsibility for the declarations made, relieving the tattoo artist Sara Liverani of any claim and action
even of third parties, and to be informed of any download, interviews, stories and images. The use of recordings, images and the narration narrated by me are to be considered free of charge. Pursuant to the provisions of Regulation (EU) 2016/678 at any time, I will have the right to revoke the authorization to process the audiovisual and photographic material collected.

Location:

Signature: