APPLICATION TO PUBLISH OR DISPLAY REPRODUCTIONS
OF ARCHIVAL MATERIAL

Name (please print): _________________________________________ Date: ________________

Address: ________________________________________________________________________

City: __________________________________ State: ________ Zip code: _________________

e-mail: ____________________________________________ Phone: _____________________

In accordance with the requirements of the LSUS Archives, I hereby request authorization to publish or display in facsimile the following item(s) from the LSUS Archives. All items will be properly credited as specified below.

Item Description:




Please describe intended use:




PERMISSION TO PUBLISH OR DISPLAY REPRODUCTIONS FROM LSUS ARCHIVES AND SPECIAL COLLECTIONS

Permission to publish or display reproductions of unique or rare materials in LSUS Archives and Special Collections requires written application.

Reproduced items are provided for one time, single edition use, and may under no circumstances be used again or transferred to other persons or institutions.

LSUS Archives and Special Collections requests notification of publication or display and a complimentary copy of a published work.

In granting permission to publish or display a reproduction of any item, LSUS Archives and Special Collections does not surrender its own right to publish or display the item or its right to grant permission for publication or display. LSUS Archives and Special Collections does not assume liability for publication or exhibition of materials to which it does not own the copyright. In such cases, it is the responsibility of the user to obtain written permission from copyright and/or literary rights owners.

Reproductions published or displayed must bear the credit line:
LSU-Shreveport Archives and Special Collections

I accept and agree to comply with the conditions as outlined.

Signature of applicant: ______________________________________ Date: ______________

LSUS Archives and Special Collections hereby authorizes the publication or exhibition of reproductions identified on the foregoing application.

Signature of Archivist: ______________________________________ Date: ______________