OUR FUTURE PAST: An Oral History Project for Retired Techies

Informed Consent

1. I hereby agree to participate in an interview in connection with the oral history project known as
_______Our Future Past______________________. I understand that I will be asked about
_______my career, my personal background, my opinions on science, technology and public science literacy____.

2. The interview will be videotaped and made available through various media, such as but not limited to, the internet,
dvd, and film. In the interview I may be identified by name. I may also be identified by name in any transcript
(whether verbatim or edited) of such interview.

3. I understand that the interview will take approximately one hour and that I can withdraw from the project without
prejudice at any time up to the beginning of the interview. In the event that I withdraw from the interview, any
recording made of the interview will be destroyed, and no transcript will be made of the interview. I understand that a
photograph of me may be taken or borrowed for duplication, and that if I withdraw from the project, the photograph
collected by the project will be destroyed.

4. I understand that, upon completion of the interview, the recording and content of the interview belong to Daniel
Salerno and any further institutions that may take over the project in the future under Daniel Salerno's sole direction.
The information in the interview can be used by Daniel Salerno, or any succeeding institution, in any
non-commercial, non-profit manner it will determine, including, but not limited to, use by researchers in presentations
and publications.

5. I understand that at the conclusion of this interview and upon signing the deed of gift, the recording(s), photograph,
and one copy of the transcript will be kept online at ourfuturepast.blogspot.com and youtube.com/user/OurFuturePast..

6. If I have questions about the oral history project, or it's procedures, I know I can contact _Daniel Salerno__ at
UniSphere Expeditions, POB 382, Newark Valley, NY 13811, (215) 668-8485 or via e-mail at
ourfuturepast@gmail.com.

____ I agree to be identified by name in any transcript or reference to any information contained in this interview.

Interviewer Signature _____________________________________

Interviewee Signature (print) _____________________________________
Address _____________________________________
_____________________________________
_____________________________________
Interviewee Phone number _____________________________________
consent date __/__/__

Contact Information:

Our Future Past

c/o UniSphere Expeditions
POB 382
Newark Valley, NY 13811
ourfuturepast@gmail.com