Consent_Form

Please obtain the necessary signatures for interviews and recording projects.

CONSENT FORM Afr__ican-American Historical Association of Newton County.__

I,_, agree to participate in the project called “The Newton County African-American History Archives,” and consent to the audiotape/videotape recording of an interview between myself and the project's interviewer(s). I grant permission to the African-American Historical Association of Newton County to use the material from the taped interview(s) in a variety of ways. These may include an edited audio tour of the community, a website, wiki, an exhibit, teaching materials, posters, book, newspapers, radio programs, TV programs, public speaking engagements, or an archive available to the public. The taped interview and any transcript that results from the interview will be the property of the African-American Historical Association of Newton County. Any photographs or other memorabilia loaned to the African-American Historical Association of Newton County will be returned to me, although copies may be used by the interviewer(s) for the above-named purposes. I understand that I will not receive compensation for the use of this material. I understand that this material is not intended to be used in any way that would be slanderous or detrimental to anyone.

Signature

__Date__

Your Name (please print)

__Address__

Tel.No._

__Email:

Interviewer(s) for African-American Historical Association of Newton County.

Name(s) (Print)__

Signature(s)_

Date