English Department, Thomas Nelson Community College

 I, _______________________________________________, having been interviewed by

 _________________________________________________ (The Author), hereby agree to permit him/her to include quotations from said interview in an article he/she is preparing for publication in Harrington Gay Men's Literary Quarterly.

I hereby waive any fee or other compensation from The Author or from Harrington Gay Men's Literary Quarterly or The Haworth Press, Inc., for the use of said quotation as aforesaid or in any republication, reprint, transcription, electronic medium, or recording of the article containing said quotations.

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    Interviewee's Signature

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    Date