I, ___________________________________, (participant) contribute my interview or folklore item(s) with ____________________________________, (interviewer / collector) to Utah State University Library’s Special Collections & Archives (hereinafter “SCA”). We (informant and collector) understand that the materials that SCA acquires are preserved and made available for scholarly and educational purposes and may be duplicated by/for SCA or affiliates (USU students & faculty, researchers, community members). We understand that SCA plans to retain the released item(s) as part of its permanent collection and that the materials may be used for exhibition, publication, promotion, and presentation on the World Wide Web (internet) or successor technology.
I (informant) grant to SCA ownership of the physical property of my participation (cassette tape(s), CD, transcript, .wav file, MP3 format, photograph(s), video, etc.) delivered to SCA and the right to use the property that is the product of my participation (or example, my interview, folklore items, performance, photographs, and written materials) as stated above. By giving permission, I understand that I do not give up any copyright or performance rights that I hold.
I also grant to SCA my consent for the use of my name, any photograph(s) or video, performances, sound effects, and voice reproduction provided by me or taken of me in the course of my participation in the interview or folklore item collection to be used, published, and copied by SCA and its affiliates, unless noted, without further approval on my part.
We (informant & collector) release SCA, and its affiliates, from any and all claims and demands arising out of or in connection with the use of such recordings, documents, and artifacts, including but not limited to, any claims for defamation, invasion of privacy, or right of privacy.
ACCEPTED and AGREED
Participant Signature ______________________________________________________________ Date _____________
Printed Name of Participant __________________________________________________________________________
Signature of Parent/Guardian (if participant is minor)_______________________________________ Date_____________
Interviewer / Collector Signature _____________________________________________________ Date _____________
Printed Name of Interviewer / Collector _________________________________________________________________
Participant Address ________________________________________________________________________________
City _____________________________________________________ State ____________________ ZIP __________
Participant Telephone (_____) __________________ E-mail (optional) ________________________________________
For reference questions: email@example.com or phone
Fife Folklore Archives, Merrill-Cazier Library, Utah State University, Logan Utah 84322-3000