Fillable Printable Simple Interview Release Template

Simple Interview Release Template

INTERVIEW RELEASE FORM

Project name: ________________________________________________________________________________

Date:________________________________________

Interviewer: ________________________________________________________________________________

Tape number:________________________________________

Name of person(s) interviewed: ________________________________________________________________________________

Address: ________________________________________________________________________________

Telephone number:________________________________________

Date of birth:________________________________________

By signing the form below, you give your permission for any tapes and/or photographs made during this project to be used by

researchers and the 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:________________________________________

Researcher’s signature: ________________________________________________________________________________

Date:________________________________________

Restriction description: ________________________________________________________________________________