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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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