Interview Release Form For the Grassroots Writing Research

Interview Release Form
For the Grassroots Writing Research Journal
ISU Writing Program
Department of English
Illinois State University
Normal, IL 61790
(excerpted from the Association of American University Presses’ Permission FAQs,
http://www.aaupnet.org/aboutup/issues/copyright/permfaqa.pdf )
I understand that __________________________________________ (the Author) is preparing, writing, and will publish a work on
the subject of _____________________, which is currently titled ________________________________________ (the Work) for
publication in the Grassroots Writing Research Journal. In order to assist the Author in the preparation of the Work, I have agreed to
be interviewed and to provide information and other materials to be used in connection with the Work, including my personal
experiences, remarks, and recollections as well as any photographs and documents that I may choose to give to the Author (the
Interview Materials).
I hereby grant and assign to the Author and his/her licensees, successors, and assign the following rights in connection with the
Interview Materials for use as part of the Work or any advertising, packaging, or promotional materials for the Work, in any and all
editions, versions, and media, in perpetuity and throughout the world.
1.
2.
3.
The right to quote or paraphrase all or any portion of the Interview Materials, and to generally use and publish the Interview
Materials, including my experiences, recollections, incidents, remarks, dialogue, actions, and information, as well as any
photographs and documents that I may give to the Author.
The right to use my name, image, and biographical data (Note: authors may choose to create pseudonyms for various reasons, but
neither the author nor the journal can guarantee anonymity).
The right to develop, produce, distribute, advertise, promote, or otherwise produce the Work as part of the GWRJ. I understand
and acknowledge that the Author holds the copyright for this work, but that the GWRJ also maintains the right to reproduce the
Work as part of the journal.
In order to enable the Author to develop the Work in any manner that the Author may deem best, I hereby release and discharge the
Author and his/her licensees, successors, and assigns, from any and all claims, demands, or causes of action that I may have against
them by reason of anything contained in the Work, or any of the above uses, including any claims based on the right of privacy, the
right of publicity, copyright, libel, defamation, or any other right. In consideration of the foregoing, the Author has agreed to provide
me with one free copy of the Work in its first edition upon publication. I acknowledge and agree that I am not entitled to receive any
other form of payment from the Author and/or his/her licensees, successors, and assigns.
Agreed and confirmed:
__________________________________________
__________________
Signature
Date
__________________________________________
Author Signature
__________________
Date
Note: If you have questions about this form our about the Grassroots Writing Research Journal, please contact us
([email protected]), or contact the ISU Writing Program at 309-438-3957.