Archives Image Reproduction Request Contact Information Date (YYYY-MM-DD) Name(required) organization Email(required) Phone address Applies for permission to reproduce: item title date of item item description Intended Use non-profit educational commercial In the following publications (check one): book exhibition catalog website OTHER other title author date (YYYY-MM-DD) publisher language print run ACKNOWLEDGEMENT The publisher may use the image for one-time use only in connection with the agreed-upon publication. Any subsequent use of photographic materials must be requested in writing to the Registration Office. Reynolda House Museum of American Art holds copyright to most of the materials housed in its archival collections. Potential publishers of written works that quote, paraphrase, and/or contain reproductions of material from the Museum’s archival collections must be granted permission to publish by a Museum representative. The publisher agrees to use correct citations in the following form: (item identification, date, collection title if applicable), Reynolda House Museum of American Art Archives. In providing permission to publish materials obtained from its archival collections, Reynolda House does not assume any responsibility for infringement of copyright or of publication rights for materials that might be held by others. The publisher assumes all responsibility for obtaining permission from any additional copyright holders and is subject to any claims under the Copyright Law of the laws of libel that could be made as the result of the publication. In giving permission to publish materials obtained from its archival collections, Reynolda House does not surrender its own rights to publish the material or grant permission to others to publish them. Digital images will not be sent until an image request form has been filed, an agreement signed by both parties, and payment received (if applicable). I AGREE submit