Request for Permission to Reproduce or Publish

Request for Permission to Reproduce or Publish

Please complete this form to request permission to reproduce or publish materials held by the City of Savannah Municipal Archives.

For any questions, please contact the Archives at Archives@Savannahga.gov or (912) 651-6412

Instructions and Policies

Please initial to acknowledge your agreement with each policy.

1. Please include all items requested for one project on this form. Please submit a new form for each unique project or publication.

1. Initials*

2. Complete form in its entirety – incomplete forms will not be approved.

2. Initials*

3. A written response will be returned to you. Permission is only granted in writing.

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4. Permission is granted for one-time use only and is only valid for the use for which it was specifically issued. In order to use the same materials again in a separate publication/project, you must reapply for permission.

4. Initials*

5. Permission is only valid for the individual, company or institution to which it is specifically issued and may not be transferred, assigned, sold, or otherwise disposed of.

5. Initials*

6. Possession of reproductions does not constitute permission to reproduce or publish

6. Initials*

7. The City of Savannah reserves the right to refuse permission if it feels fulfillment of that request would be in violation of copyright law or other law.

7. Initials*

8. Public, nonprofit, academic, and scholarly uses are encouraged. Requests for commercial for‐profit uses are subject to review.

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9. One copy of the publication in which the material appears will be submitted to the City of Savannah Municipal Archives in a timely fashion and free of charge. For electronic publication, the final URL will be submitted upon

launch / release. Failure to provide a publication copy may result in future request denials.

9. Initials*

Applicant Information

Name (First and Last)*

Title

Organization you're Representing*

(or self)

Street Address*

City*

State*

Zip Code*

Email Address*

Telephone Number*

Phone

Publication Details

Other:

Please explain

Title / Project Description*

Creator*

Author, Producer, etc

Estimated Release Date*

Publisher / Network*

Circulation Quantity*

or estimated audience size.

Website Address

Materials Requested for Use / Publication

All requests for use MUST include: Collection number, collection name, Item number, and Item Title or Description.

How many items are you requesting to reproduce?

One Item

Multiple Items

To request multiple items, please attach document listing the requested items here*

Include all identifying collection information, including Collection Number, Collection Name, Item number, and Item title or description. Links to items on the Digital Collections Page may also be included.

Drag and drop files here or

Collection Number*

Box Number

Folder Number

Item Number*

Item Title / Description*

For Text Quotes:

Paste exact text to be quoted

Citation Information

Please initial to acknowledge your agreement with this policy.

ALL MATERIALS MUST BE CREDITED AS FOLLOWS:

Courtesy of the City of Savannah Municipal Archives.

Failure to credit materials may result in denial of future requests.

Printed materials: credit should appear adjacent to image or in a note easily

accessible

Films, broadcast or video productions: credits may be consolidated at end of

production

Exhibitions: credit should appear adjacent to image

Website: credit should appear adjacent to image

Accompanying credit or label should indicate any and all changes or alterations made to the original copy (exclusive of standard cropping and resizing).

The collection name should accompany credit line when practical.

Initials*

Agreement:

I agree to all the Terms and Conditions set forth by the City of Savannah and

assume full responsibility and any attendant liability for the fair use of materials

requested in total compliance with the copyright law of the United States (Title

17, United States Code) or other rights of third parties that may arise through the

use of the requested materials, and further agree to hold harmless the City of

Savannah from and against any and all damages and claims.

I agree to all policies and procedures put forth in this document.*

E-Signature*

Date signed*

Send me a copy of my responses

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