CONSENT FORM

By signing the following consent form, you are agreeing to participate in a survey regarding the use of web advertising and its affect. your answers will be recorded and used as evidence and will contribute to the overall findings of the research.



SWINBURNE UNIVERSITY OF TECHNOLOGY
NATIONAL INSTITUTE OF DESIGN
Consent form for persons participating in research projects
The Music of Multicultural Melbourne
Name of participant:_________________________________________________________________
Name of investigator(s):______________________________________________________________
1. I consent to participate in the project named above, the particulars of which –including details of the
self-documentation kit –have been explained to me. A written copy of the information has been given to
me to keep.
2. I authorize the researcher or his or her assistant to use with me the self-documentation kit referred to
under (1) above.
3. I acknowledge that:
(a) The possible effects of the self-documentation kit have been explained to me to my
satisfaction;
(b) I have been informed that I am free to withdraw from the project at any time without
explanation or prejudice and to withdraw any unprocessed data previously supplied;
(c) The project is for the purpose of research
(d) I have been informed that the confidentiality of the information I provide will be safeguarded
subject to any legal requirements.
Signature______________________________________________________Date / /
(Participant)
Signature______________________________________________________Date / /
(Witness)