As part of a research project on XXX, we are making a photographic and/or video recording of the operations you perform with one or more interfaces to computer systems. We would like you to indicate below what uses of these records you are willing to consent to. This is completely up to you. We will only use the records in ways that you agree to. In any use of these records, your name will not be identified.
Please initial all those statements that you agree to.
The records can be studied by the research team for use in
research reports. _____
The records can be shown to subjects in other experiments.
_____
The records can be used in scientific publications. ______
The records can be shown at meetings of scientists interested in the study of human-computer interaction and information access. _____
The records can be shown in public presentations to nonscientific groups. _____
I have read the description and give my consent for the use of the records as indicated above.
Name (printed): ______________________________
Signature: ___________________________________ Date
_______________________