The Heart of Marine Park: Oral Histories from the Neighborhood
Participation Release Form
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
When and Where Were You Born?
Where did you grow up? What neighborhood, state, or country?
When did you live in Marine Park? For how long?
What do you think best identifies Marine Park as a neighborhood? Describe the neighborhood.
What is your favorite neighborhood memory?
Please use this to attach any photographs or documents you'd like to share.
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I voluntarily agree to be interviewed for Marine Park 100 – Oral History Project in person or via written submission. I understand that the following items maybe created from my interview: an audio and/or video recording, an edited transcript and summary, a photograph of me, copies of any personal documents or additional photos that I wish to share I understand that my interview (and other items above) may be distributed to the public for educational purposes, including formats such as print, public programming, and the Internet. Also, I agree to freely share my interview(and other items above) under the terms of a Creative Commons Attribution-Non Commercial-Share Alike 3.0 Unported License. I retain the copyright, but the public may freely copy, modify, and share these items for noncommercial purposes under the same terms if they include the original source information. In return, the interviewer promises to send one free copy of the interview recording, transcript, and related items to my address above. Any exceptions to this agreement must be listed below:
Please let us know if you'd like to be contacted for an in-person interview.
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