Attachment_B_NPS_Materials_Release_Form.doc

Harpers Ferry Center

PO Box 50

Harpers Ferry, WV 25425

NPS Materials Release Form Attachment B

National Park Service

U.S. Department of the Interior

I agree to participate in a National Park Service production and grant the National Park Service the absolute and irrevocable rights and permission to use material of me and/or my group from (check all that apply):

O Motion Picture, Video and/or Still Photography O Narration/Voice Over

O Audio Recordings O Oral History Interview

O Music Recordings O Artwork/ Graphics

I agree that the above referenced material can be used in (check all that apply):

O The below-referenced National Park Service program

O Future National Park Service productions

O Productions outside of the National Park Service

I agree that the above-referenced material can be used in the following manner (check all that apply):

O Non-commercial, Educational, and Archival Use O In Perpetuity

O Public Broadcast O Distribution

O Commercial Educational Use – sold for private O Unlimited Rights home use (non-profit sales only)

Indemnification

I agree to indemnify and hold the Government harmless for any and all losses, claims, expenses, suits, costs, demands and damages or liabilities on account of personal injury, death, or property damages of any nature whatsoever and by whomsoever made, arising out of the activities associated with the production in which I am taking part in.

I agree, that as the signee of this release form, I must consent, in writing, to any additional use of the above-referenced material not agreed to in this form.

Print Name and Title: ___________________________________________________________________

Your Signature: ______________________________________________ Date: ___________________

Address: _____________________________________________________________________________

City: ________________________________________ State: __________ Zip Code: __________

Telephone (please include Area Code): _____________________________________________________

Organization/Group Name (if applicable): __________________________________________________

Privacy Act Statement

This information is provided to comply with the Privacy Act (PL 93-579). 5 U.S.C. 301 and 7 CFR 260 authorize acceptance of the information requested on this form. The data you furnish will be used only to provide Harpers Ferry Center with contact information pertaining to this release form.

FOR OFFICE USE ONLY:

Park Program Date AV Rep

Attachment B – Page 1 of 2 Revised 06/06/2002

Release Form Definitions

Non-commercial, Educational and Archival Use:

Non-commercial: The material used, whether, for example, in a video, audio or interactive program, will not be sold.

Educational: The material will be used to educate viewers in a particular subject matter. For example, the material may be used in an interactive computer program in a National Park Service Visitor Center, a video shown at the National Park Service Visitor Center, or an audio station used in an exhibit at a National Park Service Visitor Center. This could be both non-commercial and commercial.

Archival: The material can be accessed by anyone for research purposes.

In Perpetuity: There are no time restraints on the use of this material. It can be used indefinitely into the future (forever and ever . . .).

Distribution: The material may be distributed. For example, a video production in which the material is used may be distributed to schools, state parks, other public land use sites, or to other individuals or organizations who may use it as a part of their programming.

Public Broadcast: The material may be used in a production that is broadcast on a television station, such as a local PBS affiliate.

Commercial Educational Use—Sold for Private Home Use (non-profit sales only):

The material may be used in a production that is sold. However, sale is non-profit. For example, a friends group of a National Park Service site may wish to sell the video shown at their National Park Service site’s Visitor Center. The proceeds of this video will in turn go towards the duplication of additional videos and DVD’s and to the National Park Service in general for other educational and support-related efforts.

Unlimited Rights: The right of the Government to use, disclose, reproduce, prepare derivative works, distribute copies to the public, and perform publicly, in any manner and for any purpose whatsoever, and to have or permit others to do so.

EXPERIENCE YOUR AMERICA

The National Park Service cares for special places saved by the American people so that all may experience our heritage.