Please print
and complete this form and mail it to:
|
LHEF, Inc. |
ORAL HISTORY (VIDEO/DVD/AUDIO)
DONOR AGREEMENT
(for Art/Photography and Special Collection use separate forms)
|
Name of Donor: _______________________ Name of Collection (if different from Donor's Name): _______________________ Address: _______________________ _______________________________ City: ___________________________ State: _________ Zip: ____________ |
Date: _________ Phone Number: ____________ E-Mail Address: _____________ |
| Collection # _______________________________ (to be filled in by LHEF) |
I agree to donate the recordings described below to the Lesbian Herstory Archives/Lesbian Herstory Educational Fund (LHEF, Inc.) to become its permanent property. All property rights of the material or objects donated are granted to LHEF. This material may be made available for viewing, listening and research, subject to restrictions that may appear below.
I understand that all responsibility to obtain publication or reproduction permission rests solely with individual researchers, not with LHEF, Inc. Researchers may make copies of these recordings for personal use instead of note taking.
Description of Recordings
and Other Accompanying Material:
(Please use back of page if more space is needed).
 |
Please Indicate:
Any copyright which the donor possesses to publish or reproduce this material in print, video, film, or other recorded format is reserved by the donor requiring written consent prior to each publication until death whereupon (check one):
_______ It is assigned to LHEF, Inc._______ Assigned at this time to LHEF, Inc.
_______ Other (as stipulated below or on reverse)
Respondent Information:
|
Respondent Signature: _______________________ Address: _______________________ _______________________________ City: ___________________________ State: _________ Zip: ____________ |
Date: _________ Phone Number: ____________ E-Mail Address: _____________ |
| LHEF, Inc. may/may not (circle one) provide researchers with my address and phone number for publication permissions. | |
Interviewer Information:
|
Interview Signature: _______________________ Address: _______________________ _______________________________ City: ___________________________ State: _________ Zip: ____________ |
Date: _________ Phone Number: ____________ E-Mail Address: _____________ |
| LHEF, Inc. may/may not (circle one) provide researchers with my address and phone number for publication permissions. | |
Restrictions:
(Please use back of page if more space is needed).
Access to and /or duplication of this material is restricted as follows:
Display of this material by LHEF is restricted as follows:
Donor Signature: _____________________________________
Received By: ______________________________________ Date:________ (to be filled in by LHEF)
LHEF, Inc. seeks material from all lesbians. Access to collections is granted without regard to academic, sexual, or political credentials. All donations are tax-deductible.