WASHINGTON AND LEE
UNIVERSITY
Lexington, Virginia 24450-0303
REQUEST FOR REPRODUCTIONS /
APPLICATION FOR PERMISSION TO REPRODUCE/PUBLISH
Name of Applicant and Title:
Organization or Agency (if appropriate):
Address:
City, State, Zip:
Phone: E-mail: Fax:
_____________________________________________________________
Intended Use of Material
____ These materials are for personal research and will not be copied,
reproduced, or publicly displayed.
____ These materials will be reproduced. Please attach a description of
the project.
Author/Director/Producer:
Title
or Description of Use:
Publisher:
Projected
Date of Publication:
Format: __Book __Magazine __Film/Video
__Advertisement
__CD-ROM/Multimedia __Online Publication __Other
Estimated
Number of Copies:
_____________________________________________________________
Description of Materials to
be Used
Call
Number / Artist or Collection / Title or Description
Conditions of Use
1.
Permission for reproduction is granted only for the expressed purpose described
in this application and is non-exclusive; Washington and Lee University
reserves the right to reproduce the image and to allow others to reproduce the
image.
2.
In addition to the permission of Washington and Lee University, additional
permissions may be required. The
applicant is responsible for compliance with all copyright and other legal
requirements applicable to reproduction.
3.
All reproductions must include the name of Washington and Lee University in a
caption or credit.
4.
Unless approved in advance by Washington and Lee University, each image MUST be
reproduced unaltered and in its entirety; the image must not be cropped,
overprinted, printed on color stock, or bleed off the page. When permission is granted to distribute an
electronic copy of an image, it shall be a low resolution digitized copy.
5.
The image must be returned to the University within six weeks of the
publication. A payment of $150.00 will
be levied for any transparency that is not returned on time.
6.
Payment of all fees is required before permission is granted.
7.
The applicant agrees to send Washington and Lee University one copy of the work
containing the reproduction at no charge.
_____________________________________________________________
Endorsements
By
signing this application, I accept personally and on behalf of any organization
I represent, the conditions set forth above.
Signature: Date:
Title:
When
signed by an authorized agent of Washington and Lee University, this form
constitutes permission for reproduction as outlined in this application.
Signed: Dated:
Title:
Washington and
Lee University
Permissions
Policy for University Special Collections
Fee Schedule
2006-2007
First
one-time commercial use of an image $ 100.00
Use of a second (different) image in same project
$100.00
Please
make checks payable to Washington and Lee University. Bill includes direct costs associated with reproducing an item in
addition to the license fee outlined above.