Town of Wytheville Department of Museums &
Wythe County Historical Society Images
PERMISSION TO REPRODUCE ITEMS FROM THE COLLECTIONS
Name:
Address:
Date: Phone:
Permission to reproduce items from the Town of Wytheville Department of Museums and/or the Wythe County Historical Society is provided based on the intended use of the material. This is not an order form for images. Please specify which of the following describes how each image requested will be used:
A. Publication/Print MediaB. ExhibitionC. Film or TV D. Video E. Commercial
F. Publication/Electronic Media G. Book Jacket/Magazine CoverH. Web use (please specify URL of site)
I. Other (must detail)
Public Display
I certify that the image(s) requested is for public display in a commercial establishment, business, or nonprofit organization only for the purpose specified. I agree not to publish the image(s) in any format. I understand that under no circumstances may the image(s) be used to advertise or endorse a product, service, or person. I agree to give credit for the image as follows: “Used with permission from the Wythe County Historical Society or the Town of Wytheville Department of Museums.” Images may not be resold, copied, or transferred. The permission to use an image does not include copyrights to the image. I agree to pay the staff time and reproduction costs for copying and distributing the image(s). I understand legal recourse may be taken if images are used for unauthorized publication.
Image(s) Requested:
Category of Use (from list):
Location of Use:
Noncommercial Use
I certify that the image requested is for my personal use. I agree not to publish the images in any format other than the noncommercial publication I discussed with museum staff. I agree to pay the staff time and reproduction costs for copying and distributing this image. I understand legal recourse may be taken if these images are used for unauthorized publication.
Image(s) Requested:
Category of Use (from list):
Where/how image(s) will be used:
Commercial Publication
I certify that the image requested is for use in a commercial publication—only for the purpose specified and only for one time usage. I understand that under no circumstances may the image be used to advertise or endorse a product, service, or person. I agree to give credit for the image “Used with permission of the Town of Wytheville Department of Museums” and/or “Used with permission from the Wythe County Historical Society.” Images may not be resold, copied, or transferred. The permission to use an image does not include copyrights to the image. The publisher is responsible for obtaining copyright permission from the image’s creator, if applicable. I agree to pay the staff time and reproduction costs for copying and distributing this image. I understand legal recourse may be taken if these images are used for unauthorized publication.
Two copies of any resulting publication will be provided to the Town of Wytheville Department of Museums and/or the Wythe County Historical Society free of charge.
Image(s) Requested:
Category of Use (from list):
Name/date of publication:
Additional Conditions Under Which Permission is Granted
l. Images are to be used only once for the purpose listed on this form. Any subsequent or different use constitutes a re-use and must be applied for in writing subject to applicable fees.
2. Users assume responsibility for questions of copyright and invasion of privacy that may arise in the use of the image(s) used.
3. The Wythe County Historical Society and the Town of Wytheville Department of Museums reserve the right to limit the number of copies, to restrict the use and reproduction of rare or valuable materials, to make special price quotations for materials involving unusual difficulty in copying, and to charge a different copying fee than specified.
4. The reproduction rights granted to you are not transferable.
5. Any WEB digital reproduction/use of the Wythe County Historical Society and/or Town of Wytheville Department of Museums images will be limited in resolution to 72 d.p.i.
6. Any exceptions or additions to the above conditions will appear on, and be considered part of, the permission form.
This form grants permission to reproduce the images(s) upon payment of the appropriate fees and when signed by a Wythe County Historical Society or Town of Wytheville Department of Museums representative. The Wythe County Historical Society and/or the Town of Wytheville Department of Museums in no way waives its right to future publication of the image(s) supplied to you or the right to grant others permission to use them. The Wythe County Historical Society and the Town of Wytheville Department of Museums do not grant rights in perpetuity
Signature: Date:
Signature of Museum/Society Representative:Date:
Fee Schedule
Reproduction Costs:
Photocopies: $0.25 per copy.
Existing Electronic Images sent through E-mail: charge $0.25 per image unless this is included in library research, in which case the policy is $15 per hour and the $0.25 per image would be waved.
Newly Created Digital Images sent through E-mail: $0.50 per image.
Newly Created Digital Images on a disk: cost of the disk plus $0.50 per image.
Cost of a Scanned Image on Photographic Paper: $2.50 per sheet of legal size paper (81/2 in. x 14 in.) and $3.00 per sheet greater than legal size plus $2.00 for every ten minutes of staff time used in scanning the image.
For Commercial Publications
Publication/licensing Fees:
Image used in a book with under 5,000 copies published: $20
Image used in a book with 5,000 to 9,999 copies published: $30
Image used in a book with 10,000 to 24,999 copies published: $60
Image used in a book cover or book jacket: $100
Total cost will be publication/licensing fee plus reproduction costs.
R:\Photography & Images Policy revised.doc
1