Note: This form must be printed out. The form is also available in .pdf [1] and .doc [2] formats.
Please Return With Payment
Subject to the conditions stated herein and upon completion and return of this form.
Name/Organization:
Addres:
is granted the right to use a duplicate image or images, described herein, from the University of Alaska Fairbanks historical photograph collections. This form does not constitute a license for use of materials where the copyright is not owned by the University. The researcher is solely responsible for the use made of any material secured from the Archives and any infringement of copyright. The Archives will make a reasonable attempt to inform the researcher of the status of rights. Reproduction of any item must contain a complete attribution statement.
Warning Concerning Copyright Restrictions
The copyright law of the United States (Title 17, US Code) governs the making of photocopies or other reproductions of copyrighted materials. Under certain conditions specified by the law, libraries and archives are authorized to furnish a photocopy or other reproduction. One of these specific conditions is that the photocopy or reproduction is not to be used for any purpose other than private study, scholarship, or research. If a user makes a request for, or later uses, a photocopy or reproduction for purposes in excess of Fair Use, that user may be liable for copyright infringement.
Identification of photographs (attach a list of photos if necessary):
Number of photographs to be used:
Accession number of photograph(s):
Title:
Publisher, director, author:
Address:
City/State/ZIP:
Telephone:
Email:
Tax identification number (for non-profit organizations only):
Theme of publication or production:
Anticipated publication date:
Estimated number of copies to be published (or serial circulation):
Name of person requesting photos (if different from above):
Address:
City/State/ZIP/Telephone:
I, (print name) agree that the photograph(s) listed on this form, purchased from the University of Alaska Fairbanks, are for one-time use only for the purpose stated (publication, personal or research use, special uses, etc.). Any further use of the images regardless of production or format will be renegotiated with the Alaska and Polar Regions Collections, Elmer E. Rasmuson Library, University of Alaska Fairbanks. I will give due credit to the University of Alaska Fairbanks and to the individual collection(s) by following the citation guidelines.
Signature of person requesting photographs______________________________________
Date:
Address:
City, State, ZIP:
Signature of Archivist_________________________ Date_____________________________
Links:
[1] http://library.uaf.edu/files/apr/statement_intended_use.pdf
[2] http://library.uaf.edu/files/apr/statement_intended_use.doc
[3] http://library.uaf.edu/intended-use-form#purchase