
Purpose: The Center has created this form to assist presses that wish to receive a signed clearance for publication of an image, once the requester has also completed the Center's Image Duplication Request Form and has submitted payment for that image duplication and use.
Title of the Book: __________________________________________________________________
Name of Author: _________________________________
Number of photographs covered by this Permission: ____
Description of photographs covered by this Permission :
1.
_________________________________
2.
_________________________________
3.
_________________________________
4.
_________________________________
5. _________________________________
1. The undersigned entity ("Licensor") is, by this Permission and subsequent to the Licensor’s receipt of payment for all fees related to such use, granting to the Author (and to companies and individuals authorized by the Author, hereafter referred to as “User”) non-exclusive world rights in all languages to reproduce the Images designated on the Center’s Image Duplication Request Form for editions of up to 5,000 volumes of the Book (whether paperback, hardcopy, and/or e-book) and to publicly distribute copies of editions of said Book containing some or all of the Images.
2. Subsequent to payment for such use, the Images may also be used by the Author and companies and individuals authorized by the Author:
(A) on the jacket or cover of the Book;
(B) in any other form of the Book or part thereof in any medium, including, but not limited to, adaptations of the Book, revised and condensed versions of the Book and excerpts from the Book in other books and periodicals ("Other Versions"); and
(C) in advertising, promotion and publicity for the Book and Other Versions.
3. Adherence to copyright laws is the sole responsibility of the User, and is not the responsibility of the Licensor. We refer the User to the following chart that describes the terms of copyright: http://www.copyright.cornell.edu/training/Hirtle_Public_Domain.htm For instance, that chart indicates that If these images were published before 1923, they are in the public domain and only the permission of the Licensor is needed to reproduce these digital images of them, as specified in the Center of Southwest Studies' Image Duplication Request Form. The Center of Southwest Studies’ digital images copyright statement is online at http://swcenter.fortlewis.edu/images/Rights.htm
4. Licensor acknowledges receipt of the sum of $ ____.___ in full payment for all rights granted by this Permission.
5. This Permission, supplemented by the Center’s completed Image Duplication Request Form, contains all of the terms and conditions relating to the license granted by this Permission.
USER:
______________________
______________________
__________________________________
____/____/_______
Signature of User
Printed name of
User
Signer’s title (as agent for the User)
Date signed by User
LICENSOR: Center of Southwest Studies, Fort Lewis College, 1000 Rim Drive, Durango, CO 81301-3999
_______________________
____________________
__________________________________
____/____/_______
Signer’s signature
Printed name of
signer
Signer’s title (as agent for the Licensor organization)
Date signed by Licensor
Please include credit line(s) for the Photographs on each page where used
in the Publication. Citations should include these informational elements:
the name of the creator of the materials, the type of document cited, the call
number and title of the collection, and the repository’s name.
We recommend this format: [name of the material's creator], [title of the material referenced, if more specific than the collection as a whole], [date(s) of the material's creation], in collection [the letter and 3-digit number of the collection number], [name of collection], at the Fort Lewis College Center of Southwest Studies.
SW-97
Page last modified: December 04, 2007