Oral History Release Form

ORAL HISTORY RELEASE

Interviewee:_____________________________
DOB:_____________________________________
Sex:_____________________________________
Phone:___________________________________
Email:___________________________________
Address:_________________________________
Date & Time:_____________________________
Project:_________________________________
Subject(s):______________________________
Recording Method:________________________

I, {Interviewee Name}, hereby authorize {Interviewer Name} to interview me on {subjects} for the purpose of {project} on {date}.

I consent to transcription, audio recordings, and videotaping that contain my words, voice, likeness, performance, and image.

I authorize the Interviewer to edit, compile, assemble, produce, copy, and redistribute all images and recordings of me, provided that it is in a manner that accurately and faithfully represents my narrative as reported during this time.

I authorize the Interviewer to exhibit, advertise, present, reproduce, display, and distribute this project only for the purpose of {purposes}. I {do/do not} authorize commercial distribution of my contribution to this project.

_________________________________________
(Interviewee Signature)

_________________________________________
(Interviewer Signature)

_________________________________________
(Date)

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