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 ________________________ (signature) (signature) Address ________________________ Address ___________________________ City, State Zip ____________________ City, State, Zip ______________________ Date ___________________________ Date_______________________________