Application for Permission to Publish

APPLICATION FOR PERMISSION TO PUBLISH Applicant: ___________________________________________________________________________________ Address: ____________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ Telephone / FAX / E-mail: _ Applies for permission to reproduce: _________________________________________________________ _____ _________________________________________________________ _____ _________________________________________________________ _____ Color _____ _____ _____ B&W _____ _____ _____ Inside Cover _____ _____ _____ In the following publication: Title: ________________________________________________________________________ Publication: ________________________________________________________________________ Author: ________________________________________________________________________ Periodical name: ________________________________________________________________________ Publisher and address: ________________________________________________________________________ ________________________________________________________________________ Expected date of publication, volume, year: ________________________________________________________ Check all that apply: Commercial _____ Non profit _____ Advertising _____ Book _____ Periodical _____ Exhibit catalog _____ Dissertation _____ Textbook _____ Other ____________________ Distribution rights desired (one time use, one language) North American rights ____ World rights _____ Language ______________________ Other use: ____________________________________________________________________________________ CREDIT LINE MUST READ: U.S. Department of the Interior, National Park Service, Saint-Gaudens National Historic Site, Cornish, NH ___________________________________________________________________________________________ The applicant agrees that this permission is subject to the conditions listed on the reverse of this form and further agrees to promptly pay all applicable fees. Please complete, sign, and return both copies, attention: Rights & Reproductions. A countersigned copy will be returned to you when permission is granted. Signature of applicant: _____________________________________________________ Date: _______________ Print name and title: __________________________________________________________________________ Signed for Saint-Gaudens NHS: ______________________________________________ Date: _______________ Name and title: _______________________________________________________________________________ CONDITIONS UNDER WHICH REPRODUCTION RIGHTS ARE GRANTED FOR PHOTOGRAPHS FROM THE COLLECTION OF SAINT-GAUDENS NATIONAL HISTORIC SITE 1. All requests for permission to reproduce an image for publication must be made in writing, and include the intended use, the publisher, and expected date of publication. The publisher is to provide Saint-Gaudens NHS with two complete, gratis copies of the publication in which the image is reproduced. Send attention "Rights and Reproductions." Permission is granted for one time use as detailed on the application form. Permission to publish must be obtained in advance for each subsequent edition or reprint. Reproduction is permitted only from prints or transparencies supplied by the Site. Color reproductions must be made from a 4 x 5 inch, or larger transparency. All negatives and color transparencies remain the property of Saint-Gaudens NHS. Each image must be reproduced unaltered and in its entirety, unless approved in advance by the Superintendent, Saint-Gaudens NHS. The reproduction must not be cropped, bled off the page, nor have anything superimposed on the image. When a detail is used, the word DETAIL, must appear in the credit line. Full documentation credit, AS SUPPLIED BY SAINT-GAUDENS NHS, must appear in immediate proximity to the image, or in the section devoted to photographic credits. Abbreviations are not permitted. Saint-Gaudens NHS assumes no responsibility for any royalties or fees claimed by the artist or photographer, or on his/her behalf. Saint-Gaudens NHS reserves the right to deny permission to reproduce an image from its collection to any applicant whose product is not acceptable to the Site for any reason. Failure to pay the required fees for reproduction means that permission has not been granted. Permission is valid only for the individual, company, or institution to whom it is specifically issued and may not be transferred, assigned, sold or otherwise disposed of without written permission of the Superintendent, Saint-Gaudens NHS. In the case where copyright is held by a third party, written permission must be secured by the applicant from that party or their agent, and must accompany the application. If so requested, a proof must be approved by the Superintendent, Saint-Gaudens NHS before reproduction of an image in color. PROOF MUST BE APPROVED: _____ Yes _____ No 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13.