Agreement for use of interview

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This is an agreement that Kimberly E. O'Leary can use information obtained during an oral history interview for an educational project. Please enter the e-mail address you want me to use to contact you about this project, even if it is the same e-mail address I have already used to contat you.

Email *

What is your name? *

Do you agree to be interviewed by Kimberly E. O'Leary for the Gen Jones Chronicles? *

Yes

Required

Kimberly E. O'Leary wants to use any recordings, notes, conversations, or transcripts of any of those for the purpose of recording history and providing information and education to the general public in any way she deems appropriate. Will you allow her to use this information? *

Yes

I'd like to review the video first

Other:

Required

Which option do you choose regarding any copyright over the history you have chosen to share? Giving the copyright means whoever owns it may publish the material on the internet, in written form (such as a book or manuscript), share it at public events or any other way the copyright holder deems appropriate. It also means the holder can give permission to others to use the information. This permission includes video, audio and any supporting materials. *

I give the copyright to Kimbery E. O'Leary exclusively

I give the copyright to Kimberly E. O'Leary but I also retain the copyright to use my information myself. I understand that this option does not give me the right to use Kimberly E. O'Leary's other work. If you choose this option, either one of us can give permission for someone else to use the information.

I want the information to be in the public domain so anyone can use it without obtaining permission.

Required

I give permission for my name to be used with my stories and materials. If you choose "No", indicate in the "other" box how you want to be referred to (e.g., "60-year-old woman from Michigan, U.S.A.) *

Yes

Other:

Required

By typing my name below, I confirm that I understand this is a legal document and I am agreeing to it. Once you submit this form, you are finished. If you decide to change your answers before our interview, you can "re-submit" the form with different answers. Once the interview begins, the most recent response will control. *

A copy of your responses will be emailed to the address you provided.

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