I agree to be interviewed, photographed, filmed and/or
tape-recorded for the People and Place in
20th-Century St. Louis project. I
understand that all materials produced from this interview,
whether in tape, manuscript, electronic, film, digital,
or any other form, will be used only for
research, educational, exhibition, program, and promotional
purposes by the Missouri Historical
Society or its public.
I understand that all audio tape(s), transcript(s), film,
photograph(s), and any other materials
resultant from this interview, will become the property
of the Missouri Historical Society, which will
have the right to accession these materials into its
Library and Research Center, where they will be
made available to Society staff and to the public for
research, educational, exhibition, program, and
presentation purposes.
Signed _______________________________
Date _______________________
Interviewee:
Name ____________________________________
Address ____________________________________
____________________________________
Telephone (w) (
) ______________ (h) (
) _______________
Interviewer:
Name ____________________________________
Affiliation with Missouri Historical Society: ____________________________________
Address ____________________________________
____________________________________
Telephone (w) (
) ________________
(h) ( ) ______________________