Interview Release Form

From Khoja Wiki

KHOJAWIKI.org Family History Project

INTERVIEW RELEASE FORM

Date:________________________________________ Time:_________________________

Interviewer: ________________________________________________________________________________

Intervier number:________________________________________

Name of person(s) interviewed: ________________________________________________________________________________

Address: ________________________________________________________________________________

Telephone number:________________________________________

Date of birth:________________________________________

By signing the form below, you acknowledge that KhojaWiki.org is a non-profit organisation that is in the process of recording the personal and family histories of members of the Khoja community and that you give your permission for any recording and/or photographs made during this project to be used by KhojaWiki.org to publish on their global website as well as to release to researchers and the public for educational purposes including publications, exhibitions and presentations. By giving your permission, you do not give up any copyright or performance rights that you may hold. I agree to the uses of these materials described above, except for any restrictions, noted below.

Name (please print): ________________________________________________________________________________

Signature: ________________________________________________________________________________

Date:________________________________________

Interviewer’s signature: ________________________________________________________________________________

Date:________________________________________