Center for Popular Music

Reproduction Request Agreement

Please print this form and mail with payment to the address below.
By signing this form I agree that:

- I will not make or permit to be made additional copies of the items identified below without prior written authorization from the Center for Popular Music.

- If I cite or quote this material in any publication, presentation or performance I will fully credit the Center for Popular Music, Middle Tennessee State University, with ownership of the original.

- If I have obtained this reproduction under Fair Use provisions of the U.S. Copyright statute (17 U.S.C. 107), I certify that it will be used only for legitimate scholarly, research or classroom use and that it will not be used for any commercial undertaking. I further indemnify Middle Tennessee State University, the Center for Popular Music, and their officers and employees from and against any copyright infringement claims, suits, costs, and liabilities arising from use of the items identified below.

Item reproduced:

Title:_____________________________ ID____________________

Title:_____________________________ ID____________________

Title:_____________________________ ID____________________

Format: Photocopy___ Computer file____ Photograph____ Audio cassette____

Microfilm___ Other_______________________.

Intended use:____________________________________________________________

Signature:______________________________________________________________

Printed name:_________________________________Daytime phone:_______________

Institution/company:_______________________________________________________

Address:________________________________________________________________
 


Fee for reproduction: $__________Amount paid__________Date: __________ Staff:___________
Make checks payable to: MTSU.  We regret that we cannot accept payment via credit card.
Mail to: Center for Popular Music, Box 41 MTSU, Murfreesboro TN 37132, USA