Alabama State University
Permission to Publish
Educational / Not-for-Profit Use

List or describe requested photograph (provide identification number)  
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Indicate how the photograph is to be used, name and address of web page, type of publication, proposed name or title of publication, publication date, publisher’s name, expected date of publication.
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Indicate the nature of the publication: e.g., scholarly, popular, commercial, etc.
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Person or entity making the request (Name, address, phone number, e-mail)
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Indicate what format you would like the photograph (dimension, dpi, file format, etc.).
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By signing this form I agree that:
I will not make or permit to be made additional copies of the items identified above without prior written authorization from Alabama State University Archives.

If I cite or quote this material in any publication, presentation or performance I will fully credit:
Courtesy of Alabama State University Archives.

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 Alabama State University Archives, and their officers and employees from and against any copyright infringement claims, suits, costs, and liabilities arising from use of the items identified below.

Photographs
Prints
Publication/exhibition fee (educational/not-for-profit use): $100.00 per photographic image

Handling Instructions: Pickup_____ Mail _____ Photograph Format __________ (dimension, dpi, file format, etc.)

Signature___________________________________________

Make checks or money orders payable to: ASU. We cannot accept payment via credit card.
Mail form and payment to:
Alabama State University Archives
Levi Watkins Learning Resource Center
Alabama State University
Montgomery, Alabama 36106

Allow TWO TO THREE weeks for the copy to be made