I, ______________________________________________ (name of narrator), hereby give to the _____________________________________ (repository) as a donation this interview recorded on _______________________ (date).

With this gift, I hereby transfer to the _______________________________ (repository) legal title and all literary rights to the interview including copyright.


I understand the ______________________________ (repository) may make the interview available for research and use as it may determine, but it may not be broadcast, cablecast, or electronically published for commercial purposes without my written consent. Beyond this, my consent for use has:

__________ no restrictions

__________ restrictions as specified here:





Narrator _______________________

Interviewer ________________________

Address ________________________

Address ___________________________

City, State Zip ____________________ City, State, Zip ______________________

Date ___________________________ Date_______________________________