I hereby grant to the FFA ownership of the physical property delivered to the FFA and the right to use the property that is the product of my participation (for example, my collection or photographs) as stated above. By giving permission, I understand that I do not give up any copyright or performance rights that I may hold.

I also grant to the FFA my absolute and irrevocable consent for any photograph(s) provided by me or taken of me in the course of my participation in the course to be used, published, and copied by the FFA and its assignees in any medium.

I agree that the FFA may use my name, video or photographic image or likeness, statements, performance, and voice reproduction, or other sound effects without further approval on my part.

I release FFA and its assignees and designees, from any and all claims and demands arising out of or in connection with the use of such documents, recordings, photographs, including but not limited to, any claims for defamation, invasion of privacy, or right of privacy.

ACCEPTED and AGREED

Signature ______________________________________________________________ Date _____________________

Printed Name ____________________________________________________________________________________

Signature of Parent or Guardian (if interviewer is a minor)_______________________________ Date_________________

Address ________________________________________________________________________________________

City ______________________________________________ State ___________________ ZIP _________________

Telephone (_____) _______________________________

Relationship, if any, to informant ______________________________________________________________________

Restrictions: _____________________________________________________________________________________