1. Having agreed to conduct an oral history interview with _________________ [name of Interviewee] for the Historical Society of ________________, and its employees and agents (hereinafter "the Society"), I, __________________ [name of Interviewer], do hereby grant and convey to the Society and its successors and assigns, all of my rights, title, and interest in the recordings, transcripts and computer diskettes of interviews dated ____________, including literary rights and copyrights.

2. I authorize the Society, to duplicate, edit, publish, including publication on the Internet, or permit the use of said recordings, transcripts and diskettes in any manner that the Society considers appropriate, and I waive any claims I may have or acquire to any royalties from such use.

3. I agree that I will make no use of the interview or the information contained therein until it is concluded and edited, or until I receive permission from the Society.

_______________________________________
[Signature of Interviewer] Date

SWORN TO AND SUBSCRIBED before me this
day of , 200 .

________________________________________
Notary Public

My Commission expires ____________________

ACCEPTED this day of , 200 , by ________________, President of the Historical Society of _________________.