THIS CONSENT FORM covers the interview described below.

Date of Interview:

Interviewer:

Person Interviewed:

Interview Series:

Place:

Summary:

Length:

Additional Remarks:

I grant permission to Washington University Libraries to document the above interview through audio and video recordings, transcripts, photographs, notes and other media (hereafter referred to as materials). I understand that the materials will be owned and maintained by the Washington University Libraries as part of its Modern Literature Collection for so long as the University believes said materials to be of scholarly or historical value. The materials shall be preserved, organized, and made available for education and research in accordance with the Washington University Libraries access and use policies applicable to The Modern Literature Collection.

I wish to place the following condition upon the use of the materials, and I understand that Washington University Libraries will enforce that condition to the fullest extent possible:

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_____ OPEN. I give and assign my rights of copyright in the interview and materials to Washington University Libraries. The materials may be used by scholars approved by Washington University Libraries. Researchers may not quote from, cite, reproduce, publish or broadcast by any means the materials except with the written permission of the Washington University Libraries.

_____ MY PERMISSION REQUIRED TO QUOTE, CITE OR REPRODUCE. I retain my rights of copyright in the interview and materials during my lifetime. Researchers may not quote from, cite, reproduce, publish, or broadcast by any means the materials except with the written permission of the Washington University Libraries, in which permission I must join. Upon my death this interview becomes OPEN.