Barbara Bates Center for The Study of The History of Nursing
PERMISSION TO PUBLISH CONTRACT

Subject to the following conditions, I/we request permission to reproduce the visual images and/or documents listed on the reverse side of this Contract in the published work/and or production specified on the reverseside of this Contract.

Conditions

1. Credit line. The following credit line must be included once in full form, and in an abbreviated form thereafter for each image reproduced: "Barbara Bates Center for The Study of The History of Nursing, School of Nursing, University of Pennsylvania." For audio-video productions, the full form needs to be included only once.

2. Permission is granted for one-time use only. Photographic material may not be reused without permission of the Center.

3. Permission to publish fees for commercial productions. When a decision is made to use a given image for publication and/or production, please notify the Center and forward payment of $50.00 for each image and this form. Permission to publish is contingent on the receipt of this form and the fee.

4a. In the case of printed materials, the publisher undertakes to send the Center a copy of the publication containing the photograph(s) listed at the bottom of this Contract.

4b. In the case of audio-visual productions, the producer undertakes to send preferably the final work. Failing that, still photographs of the title frame, credits, and images used from the Center's collections.

5. The Center for The Study of The History of Nursing does not claim to control the rights of all materials in its collections. The publishing party assumes all responsibilities for clearing any copyrighted material not owned by the Center with the copyright holder. The publishing party further assumes any liability for infringement of copyrights and agrees to hold the Center and University harmless from any liability.

6. If permission is granted for the publishing party itself to photograph any visual material in the Center's collections, all such negatives must be given to the Center.

I/we hereby agree to the conditions specified above.

Signature______________________________________


Title______________________________________

Address____________________________________________________________________________

City, State, Zip____________________________________________________________________________

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For staff use only:

_____Permission is hereby granted.

Title and Date
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Format: textbook _____, trade book _____, periodical _____, motion picture film _____, video production_____, filmstrip _____, slideshow _____, advertisement _____, commercial television _____, other_______________________________.


Publisher______________________________________
Publication Date______________________________________
Address____________________________________________________________________________

Author(s)____________________________________________________________________________

Photographs to be published:

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For staff use only:

form returned (date) _____________
fee paid (amount & date) _____________
negatives returned _____________