Permission to Use Contract Perkins School for the Blind (“Perkins”) grants permission to reproduce and publish materials from its collections (“Materials”) in its capacity as owner of the physical Materials. It is the researcher’s or publisher’s (“User’s”) responsibility to obtain permission from the owners or holders of any rights in Material being quoted, reproduced or published. Publishing includes, but is not limited to any posting on the internet (e.g., websites, blogs, genealogy sites, social media), books, audio/visual productions, and magazines. Questions and clarification of intended use can be directed to Archives@Perkins.org. Terms & Conditions Credit line: A credit line must be included for all Materials used. The credit line shall read: “Courtesy of Perkins School for the Blind Archives”. This credit must be included at each reproduced image and in each footnote and endnote reference. Additional credits may be necessary if requested by donors. One-time use: Permission is granted for one-time use only. Materials may only be used for the publication described on this form and may not be reused without written permission of Perkins. In the case of internet or web-based publication, specific written permission must be obtained from Perkins prior to the use of any Materials. Copyright: This document does not grant any copyright permission or license. Perkins does not claim to own the rights to all of the Materials in its collections. The User assumes all responsibility for obtaining all reproduction permission and rights and for any infringement under U.S. Copyright Laws. On-demand and/or photographed materials: If permission is granted for the publishing party to photograph or scan any visual materials in the Perkins Archives, all such negative, positive, or digital reproduction must be returned to the Archives or destroyed after use. Contribution of copy: A copy of the publication must be provided for Perkins’ review before publication and the final publication containing the image(s) must be donated to Perkins Archives immediately after publication. (In some circumstances a copy is requested, but not required.) You must provide the Perkins Archives with the URL or internet location for all websites where the images are displayed. Image alterations: Photographs may be cropped to suit design and layout, but they may not be altered or drawn upon so that they look in any way different from the way they appear in the Perkins Archives. Right to decline and/or refuse: The Perkins Archives reserves the right to decline onsite photography. The Perkins Archives reserves the right to refuse permission to Users to reproduce, publish, or use Materials in any way for any reason. Fee: Users agree to pay all fees incurred with this request. All fees are per image, and all sales are final. Effect of non-compliance: Failure to comply with one or more of the conditions stated herein may result in the loss of any permission granted and the denial of future requests for reproductions. Liability: Users shall indemnify, defend, and hold harmless Perkins and its employees, directors, officers, and agents from and against any and all claims, injuries, liabilities, damages, losses, costs, and expenses of every kind and nature, including, but not limited to attorneys’ fees, regardless of whether caused in part by Perkins, arising out of or in any way related to (1) any injury to any person or damage to property, including Materials, arising out of User’s presence on Perkins’ property; (2) any and all other acts, omissions or errors of User; and (3) any breach or default of any term or obligation in this Contract. First Name (required) Last Name (required) Agency or Organization (required) Federal Tax ID # (non-profits) Street Address (required) Apartment # City (required) State (required) - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zipcode (required) Email (required) Phone (required) Publication Information Format (check all that apply): Personal or classroom use (required) Yes No Scholarly or Non-Profit Publications, print or digital (includes: scholarly books and journals, conference proceedings, dissertations, etc.) (required) Yes No Anticipated print run (required) - Select -Under 5,0005,001 - 50,00050,001 or moreAccompanying use in print or digital format (includes: e-books, DVDs, CD-ROMs, etc.) For-Profit Educational and Commercial Publications, print or digital (includes: textbooks, dictionaries, encyclopedias, etc.) (required) Yes No Anticipated print run (required) - Select -Under 5,0005,001 - 50,00050,001 or moreAccompanying use in print or digital format (includes: e-books, DVDs, CD-ROMs, etc.) Commercial Magazines and Newspapers (required) Yes No Circulation (required) - Select -Under 50,00050,001 - 100,000100,001 or moreAccompanying use in print or digital format (includes: internet, social media) Website/Blog/Digital Application (including: social media, computer software, smartphone/tablet applications, CD-ROMs, etc.) (required) Yes No Film, Documentary, Television/Internet Broadcast (required) Yes No Accompanying use in print or digital format (includes: DVD, internet, educational, and promotional use) (required) Yes No Exhibit or Display (required) Yes No Type (required) - Select -TemporaryPermanentTravelingSignage Author(s) (required) Title (required) Publisher (required) Date (anticipated) (required) Year Year20162017201820192020 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Materials requested (required) Please provide the description, Flickr.com URL, or digital identifier for each image and intended placement.