Name of Interviewee __________________________________   Sex ________  Ethnicity ___________

Current Address _____________________________________   Date of Birth  ____________________

                             _____________________________________   Place of Birth ____________________

                             _____________________________________   Telephone  (_____) _______________

             City or Town                           State                                            Dates of Residence
1. ____________________________________________         _______________________________
2. ____________________________________________         _______________________________
3. ____________________________________________        _______________________________
4. ____________________________________________         _______________________________
5. ____________________________________________          _______________________________

          Job Title/Duties                      Employer                                         Dates of Employment

1. ____________________________________________          _______________________________
2. ____________________________________________          _______________________________
3. ____________________________________________          _______________________________
4. ____________________________________________         _______________________________
5. ____________________________________________          _______________________________

In view of the historical value of this interview, I, ________________________________, do hereby give to the University of South Florida St. Petersburg for such scholarly and educational uses the University shall determine the tape-recorded interview(s) on ____________________ as an unrestricted gift.  I knowingly and voluntarily transfer to the University of South Florida St. Petersburg legal title and all literary property rights, including copyright.  I also give permission for the University, it agents, or assignees to preserve these recordings in alternative digital formats and place the contents thereof in an electronic format available to researchers within the library as well as through the Internet or other networks.  This gift does not preclude any use that I may want to make of the information or recordings myself.  This agreement may be revised or amended by mutual consent of the undersigned parties.

_______________________         ______________________________          ___________________
Signature of Interviewee             Signature of Interviewer                                      Name of Interviewer

_______________________         ______________________________          ___________________
Location of Interview                  Institutional Affiliation of Interviewer             Date of Interview

Oral History Release Form, Revised 2002/04/01(html format)
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