RELEASE FORM
I,_____________________________, am a participant in the_______________________
project, (hereinafter "project"). I understand that the purpose of the project
is to collect audio- and video-tapes and selected related documentary materials
(such as photographs and manuscripts) that may be deposited in the permanent
collections of __________________________________. The deposited documentary
materials may be used for scholarly, educational, and other purposes. I understand
that the ____________________ plans to retain the product of my participation as
part of its permanent collection and that the materials may be used for exhibition,
publication, presentation on the World Wide Web and successor technologies, and
for promotion of the institution and its activities in any medium.
I hereby grant to _____________________________ ownership of the physical
property delivered to the institution and the right to use the property
that is the product of my participation (for example, my interview,
performance, photographs, and written materials) as stated above. By
giving permission, I understand that I do not give up any copyright or
performance rights that I may hold.
I also grant to_____________________________ my absolute and irrevocable
consent for any photograph(s) provided by me or taken of me in the course
of my participation in the project to be used, published, and copied
by ______________________________ and its assignees in any medium.
I agree that_______________________________ may use my name, video or
photographic image or likeness, statements, performance, and voice
reproduction, or other sound effects without further approval on my part.
ACCEPTED AND AGREED
Signature___________________________________________Date________________
Printed name____________________________________________________________
Address_________________________________________________________________
______________________________________________Zip__________--___________
Telephone ( )________ - ___________
Fax ( ) ________ - ___________
Email ____________________________________
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