Agreement for Use of Photographs and Digital Images from Scottsville Museum's Archives
In the space provided below, please describe fully the intended use of the referenced image(s) such as publication, video, exhibition, or personal research. If for publication, list the author, title, publisher, and date. If for exhibition, list the exhibit's title, the institution, and duration of exhibit.
Description of Use:
Conditions of Use
The Applicant Agrees:
1. To use the image(s) only for the purpose or project stated above.
Later and different use constitutes reuse and is prohibited. Subsequent requests for permission
must be made in writing. A reuse fee may apply.
THE APPLICANT HEREBY AGREES WITH AND ACCEPTS THE ABOVE-STATED CONDITIONS:
Applicant's Name (Printed):
Authorization for Use
(To be completed by Scottsville Museum)
To the extent that it has legal authority to do so, Scottsville Museum hereby gives its consent for the release of the image(s) referenced to the applicant under the conditions and for the purpose described herein. This consent does not imply that Scottsville Museum controls the copyright to the image(s) or that the applicant should not secure other authorizations prior to use.
Permission to reproduce the above item(s) is approved denied
For Scottsville Museum:
Scottsville Museum · P.O. Box 101 · Scottsville, Virginia 24590
Phone: 434-286-2247 · Fax: 703-573-4502
Scottsville Museum · 290 Main Street · Scottsville, Virginia 24590 · 434-286-2247
www.avenue.org/smuseum · firstname.lastname@example.org
Copyright © 2001 by Scottsville Museum