to use my oral history memoirs which were recorded on the following date(s):

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It is my understanding that the original tape or an acceptable copy will be donated and become the property of the

I understand that the Center will allow qualified scholars to listen to the tapes and use the interviews for their research. In addition, I wish to grant qualified researchers my permission to use the materials in connection with their research or for other educational purposes.

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Signature of Interviewee                                                                    Date

Address:___________________________

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Phone number_______________________

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Signature of Interviewer                                                                   Date

Address: __________________________

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