Without expectation of compensation or other remuneration, now or in the future, I

hereby give my consent to use my image and likeness and/or any interview statements
from me, record my voice and use those recordings in whole or in part for the purpose
of creating a University project. I understand this work may be kept by the University
and used for educational purposes and/or may be displayed to the public.

This consent is given in perpetuity, and does not require prior approval by me.

Signature:______________________
Date:__________________________
Name:_________________________