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Consent to Use Name

This form is solely for participants of the Oral History Project who have been interviewed by a member of the Waterloo Centre for German Studies.

I, _______________________________, understand that the University of Waterloo wishes to use information from an interview I participated in that was conducted as part of the Waterloo Centre for German Studies’ Oral History Project.

I hereby grant the University of Waterloo the following permissions:

To include my name: __________ yes  __________ no

To keep my identity anonymous: __________ yes  __________ no

Date: _________________________________________

Name: ________________________________________