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I,_____________________________, am a participant in the_______________________ 
project, (hereinafter "project").  I understand that the purpose of the project 
is to collect audio- and video-tapes and selected related documentary materials 
(such as photographs and manuscripts) that may be deposited in the permanent 
collections of __________________________________.  The deposited documentary 
materials may be used for scholarly, educational, and other purposes. I understand 
that the ____________________  plans to retain the product of my participation as 
part of its permanent collection and that the materials may be used for exhibition, 
publication, presentation on the World Wide Web and successor technologies, and 
for promotion of the institution and its activities in any medium.

	I hereby grant to _____________________________ ownership of the physical 
	property delivered to the institution and the right to use the property 
	that is the product of my participation (for example, my interview, 
	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 may hold.

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

	I agree that_______________________________ 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.


Printed name____________________________________________________________
Telephone (          )________  - ___________ 
Fax (             ) ________ - ___________
Email ____________________________________

Library of Congress
American Folklife Center
March 22, 2005