Interview Permission Form

__________________________("Author") has informed me that he/she is researching, writing, and publishing one or more books and related works on the subject of ____________________________________________ (collectively "the Work"), and has asked me to grant interviews and to otherwise cooperate with Author in connection with the Work.

In order to assist 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 Author ("the Interview Materials").

I hereby grant and assign to Author, and his/her licensees, successors and assigns, 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. 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, characters, dialogue, actions, scenes, situations, and information, as well as any photographs and documents that I may give to Author.
2. The right to use my name, image, voice, likeness, and biographical data.
3. The right to develop, produce, distribute, advertise and promote the Work as a book or any other work in any manner that Author deems appropriate. I understand and acknowledge that Author will be the sole owner of all copyright and other rights in and to the Work.

In order to enable Author to develop the Work in any manner that 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, slander, or any other right.

I acknowledge and agree that I am not entitled to receive any form of payment from Author and/or his/her licensees, successors, and assigns.

Agreed and confirmed:

^{Printed Name / Date}

^{Signature / Date}