Consent_form_Nantucket


 * CONSENT FORM**
 * Black Heritage Trail Audio Project**

I, ______________, agree to participate in the project called “Black Heritage Trail Audio Project,” and consent to the audiotape/videotape recording of an interview, song, or performance between myself and the project's interviewer(s). I grant permission to Brandeis University’s Cultural Production program and the Museum of African-American History to use the material from the taped interview(s) in a variety of ways. These may include an edited audio tour of the community, a website, an exhibit, teaching materials, posters, book, newspapers, radio programs, TV programs, public speaking engagements, or an archive available to the public. The taped interview and any transcript that results from the performance or interview will be the property of the Brandeis University and the Museum of African-American History. Any photographs or other memorabilia loaned to project will be returned to me, although copies may be used by the interviewer(s) for the above-named purposes. I understand that I will not receive compensation for the use of this material. I understand that this material is not intended to be used in any way that would be slanderous or detrimental to anyone.

__Signature____Date__

__Name (please print)__

__Address__

__Tel.No._____

Email:__

Interviewer(s) for the Black Heritage Trail Audio Project:

Name(s) (Print)

__Signature(s)___

__Date____