RELEASE and CONSENT –[Name of Your Project]


[Your Name] is actively involved in a research project [specify topic] and plans to write articles and a book and make conference presentations detailing insights from that research. As part of this effort he will need to quote people like you whom I have interviewed. By signing the following release form you will give [Your Name] permission to cite you in this interview.





I (the undersigned) do hereby consent to and grant to [Your Name] the right to cite my reflections in this taped interview.  I understand and agree to ALL of the following in conjunction therewith:


  • [Your Name] may cite my words and use them in writing and publications.
  • I will receive no monetary compensation for these citations.
  • I have no literary property rights, copyrights, or other interest in the resulting recordings, or publications.


I am over eighteen (18) years of age and have read this release and consent and intend it to be a binding instrument.


Name __________________________________________________________________                                                                      


Address ________________________________________________________________


City _____________________________ State _____________ Zip Code ___________


Signature _________________________________________ Date _________________

  • No labels