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 Department of Special Collections 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 University's Department of Special Collections access and use policies. I further consent to the transcribing, typing, printing, publication, and broadcast of said materials by Washington University in St. Louis, or its designated agents. I give and assign my rights of copyright in the interview and the materials to Washington University Libraries.

Notes: