Fillable Printable Sample Interview Release Form

Sample Interview Release Form

Sample Interview Release

(Take from the Association of American University Presses’ Permission FAQs,

http://www.aaupnet.org/aboutup/issues/copyright/permfaqa.pdf)

I understand that __________________________________________ (the Author) is preparing,

writing, and will publish a work on the subject of _____________________, which is currently

titled ________________________________________ (the Work).

In order to assist the Author in the preparation of the Work, I have agreed to be interviewed and

to provide information and other materials to be used in connection with the Work, including my

personal experiences, remarks, and recollections as well as any photographs and documents that I

may choose to give to the Author (the Interview Materials).

I hereby grant and assign to the Author and his/her licensees, successors, and assigns the follow-

ing rights in connection with the Interview Materials for use as part of the Work or any advertising,

packaging, or promotional materials for the Work, in any and all editions, versions, and media, in

perpetuity and throughout the world.

1. The right to quote or paraphrase all or any portion of the Interview Materials, and to generally

use and publish the Interview Materials, including my experiences, recollections, incidents, re-

marks, dialogue, actions, and information, as well as any photographs and documents that I may

give to the Author.

2. The right to use my name, image, and biographical data.

3. The right to develop, produce, distribute, advertise, promote, or otherwise exploit the Work as a

book or any other Work in any manner that the Author or his/her assigns deems appropriate. I un-

derstand and acknowledge that the Author or his/her assigns will be the sole owner of all copyright

and other rights in and to the Work.

In order to enable the Author to develop the Work in any manner that the Author may deem best,

I hereby release and discharge the Author and his/her licensees, successors, and assigns, from any

and all claims, demands, or causes of action that I may have against them by reason of anything

contained in the Work, or any of the above uses, including any claims based on the right of privacy,

the right of publicity, copyright, libel, defamation, or any other right.

In consideration of the foregoing, the Author has agreed to provide me with one free copy of the

Work in its rst edition upon publication. I acknowledge and agree that I am not entitled to receive

any other form of payment from the Author and/or his/her licensees, successors, and assigns.

Agreed and conrmed:

__________________________________________ __________________

Signature Date

__________________________________________

Name (print)