Interview Release Form

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INTERVIEW RELEASE FORM

Project name: ___________Tell Me a Story_______________________________________

Date:________________________________________

Interviewer: _________________________________________________________________

Name of person(s) interviewed __________________________________________________

Relationship to Interviewer: _____________________________________________________

By signing the form below, you give your permission for any tapes and/or
photographs made during this project to be used for public for educational purposes
including publications, exhibitions, World Wide Web, and presentations.

By giving your permission, you do not give up any copyright or performance rights
that you may hold.

I agree to the uses of these materials described above, except for any restrictions,
noted below.*

Name (please print):

_____________________________________________________________________________

Signature:
_____________________________________________________________________________

Date:________________________________________

Interviewer’s signature:
_____________________________________________________________________________

Date:________________________________________

*Restriction description:

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