The Southwest Michigan Black Heritage Society

I support my child, , in applying for the "Telling the Kalamazoo
Community Race Story" Oral History Project and agree that he/she, if chosen, will be able to
attend the interview session on October 3, 2009 at the Public Media Network offices, 359 S.
Kalamazoo Mall and the training sessions at the Public Media Network offices on
October 10 and October 14. I also give permission for my child's likeness to be used for
promoting the "Telling Kalamazoo Community Race Story" project.

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As a parent or guardian I agree with the above
As a parent of guardian I disagree with the above

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