(Please print out this page, fill in the relevant information,
and mail or fax it to the Center at the address at the bottom of the page.)
The Center for Popular Music grants ____________________________________________________________
permission to use images of ___________________________________________________________________
__________________________________________________________________________________________
from the Center's photograph archives for the following purpose:_______________________________________
__________________________________________________________________________________________
provided the following guidelines are followed:
1. All costs incurred in making photograph reproductions will be paid by:
_____________________________________________________________________________________
2. For each photograph requested, a $ ___________ use
fee will be paid for a total of $ __________________
(Duplication costs and research time extra.)
3. The Center for Popular Music requires the following credit (or equivalent):
From the collections of the Center for Popular Music, Middle Tennessee State University
4. No further reproductions of the Center's photographs will be made by the client except whatever working copies may be necessary in carrying out the project.
This permission applies to a one time use only as indicated
above. The Use Fee applies to each print requested, not based upon
publication of the materials. By granting permission to use the photographs
in the collections of the Center for Popular Music, the Center makes no
representation that it possesses any right or authority to publish, broadcast,
or otherwise use or reproduce the images (including the persons) contained
therein. This permission is conditioned upon your agreement, evidenced
by your signature below (i) to secure the permission of all persons having
any rights in the photographs or the publication thereof before making
any reproduction or publication of any of the photographs and (ii) to indemnify
and hold The Center harmless from and against any claim, action, liability
or expense arising from or out of your breach of the provisions of this
agreement or your use of any photograph pursuant to this agreement.
| ______________________________________
Company or institution (if applicable) |
_______________________________________
Name of individual making request |
| ______________________________________
Address |
_______________________________________
Signature of requester |
| ______________________________________
City, state, ZIP code |
_______________________________________
Date |
Center for Popular Music
Box 41 -- Middle Tennessee State University
Murfreesboro, TN 37130 USA
Fax: 615-898-5829