Photo Rights & Reproductions

Application for permission to reproduce objects in the collection of The Mattatuck Museum

Submitted by rpdesign on February 1, 2010 - 1:41pm

Requester information

Title:

First Name: *

Last Name: *

Job Title (if applicable):

Institutional Affiliation (if applicable):

Institutional Status:

For-profit Organization

Nonprofit Organization

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City: *

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Telephone Number: *

Fax Number:

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Object to reproduce #1

ID Number: *

Artist/Maker:

Title of work/Object Name:

Medium/Other Relevant Information:

Image View:

Format: *

Object to reproduce #2

ID Number:

Artist/Maker:

Title of work/Object Name:

Medium/Other Relevant Information:

Image View:

Format:

Object to reproduce #3

ID Number:

Artist/Maker:

Title of work/Object Name:

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Image View:

Format:

Object to reproduce #4

ID Number:

Artist/Maker:

Title of work/Object Name:

Medium/Other Relevant Information:

Image View:

Format:

Object to reproduce #5

ID Number:

Artist/Maker:

Title of work/Object Name:

Medium/Other Relevant Information:

Image View:

Format:

Intended Use

Intended Use of the Object(s) Requested* (select all that apply)

Check all that apply:

	Yes	No
Study/Personal Use
Broadcast or Film Production
Application is for reproduction to appear on a dust cover, book cover, brochure, calendar, for advertising or promotional purposes or as an individual reproduction.
Application is for reproduction of a work created after January 1, 1976

If for editorial use, please describe:

Title:

Author:

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Expected date of publication:

Other Use:

Describe fully the proposed use, format, size, etc. Please be as complete as possible.

Comments:

Any additional information that you wish to include.

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