Film Archival Inclusion Consent Form
Please provide your information and consent for inclusion in the film archive.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Project or Film Title
*
Your Role or Relationship to the Project (e.g., Participant, Interviewee, Contributor)
*
Please Select
Participant
Interviewee
Contributor
Crew Member
Other
Signature (Please sign below to confirm your consent)
*
Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Additional Comments (optional)
Submit Consent
Submit Consent
Should be Empty: