PC-837 Peace Corps 50th Anniversary Archive Project: Material S

OMS Control #

Expiration Date:

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Peace Corps 50 lh Anniversary Archive Project

Material Submission

Authorization and Agreement

I,

, on behalf of myself, heirs and assigns, do represent and agree to the following:

1). I am the lawful copyright or intellectual property right holder of the material submitted under this Authorization and Agreement
which permits me to provide this material to the Peace Corps under this Authorization and Agreement.
2). I forever grant the Peace Corps a perpetual, worldwide, royalty-free, non-exclusive license in and right to sub-license the
materials submitted, and authorize the Peace Corps to make any use of this material. It is my intention to give the Peace Corps the
right to disseminate, reproduce, publish, publicize and make any uses of the materials submitted under this Authorization and
Agreement, for any purposes whatsoever, through any forum or media possible. By submitting this material, it is my intention to
provide the Peace Corps with the maximum reproduction, dissemination, publication, and all other possible usage rights possible by
law.
I understand that the Peace Corps may attribute my submission to me, and I hereby authorize the Peace Corps to make any
reference to me in regard to these materials. By submitting material to the Peace Corps under this Authorization and Agreement, I
understand and agree that this miilElrial will be SUbject to public disclosure under the Freedom of Information Act, may be made
accessible to the pUblic by the Peace Corps, and may be submitted to the National Archives and Records Administration and
therefore publicly accessible.
3). I understand that the Peace Corps reserves the right to accept, reject or edit all submissions in whole or in part. Any submission
under this Authorization and Agreement, if accepted by the Peace Corps under the terms of this Agreement, may be used,
maintained or disposed of in the sole discretion of the Peace Corps. I acknowledge that regardless of whether the submission is
accepted or rejected by the Peace Corps, it may not be returned to me.
4). A description of the submitted materials is as follows:

5). I acknowledge that I will receive no financial compensation from the Peace Corps in consideration of my agreement to this
Authorization and Agreement, or in regard to my provision of the above listed submissions.
6). My submission of this Authorization and Agreement and affirmative indication of acceptance of the terms of this Authorization
and Agreement, through any physical, electronic, fax, or other means serves as my legally valid signature to this Authorization and
Agreement, and has the full force and effect of my original written signature.

Signature:
Name (Print):
Date:

PC-837 (06/2008)

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