Permissions Form

JEWISH HISTORICAL SOCIETY OF GREATER HARTFORD
333 Bloomfield Avenue, West Hartford, CT. 06117

PERMISSION FOR USAGE FORM

Request for permission to publish, display or broadcast reproductions from the collection of the Jewish Historical Society of Greater Hartford.

The Jewish Historical Society of Greater Hartford has not determined copyright status for many of the photographs and audiovisual materials in our collection. Therefore, the Society is acting only as an owner of the physical original, unless we have in our possession a written conveyance of copyright from the creator or his/her heirs. The Society is not responsible for either determining the copyright status of the image(s) or for securing copyright permission. Possession of a Society photograph does not constitute permission to use it. Users of materials must complete and return this permission form and pay all applicable fees. Please return this form to: Executive Director, Jewish Historical Society of Greater Hartford, Zachs Campus, 333 Bloomfield Avenue, West Hartford, CT 06117. For further information please contact the Society at: jhsgh@jewishhartford.org or 860 727-6171.

Name_______________________________________________________________

Institution or Company ___________________________________________________

Address________________________________________________________________

City _____________________________ State _________ Zip_________

Phone_______________________ E-Mail ________________Fax________________

Title of Publication/Work: _______________________________________________

INTENDED USE: (please check all that apply)
__ Advertising/Promotion __ Book __ CD-Rom __ Commercial/Trade Publication
__ Decorative Use or Display __ Exhibit __ Film __ Newspaper(s)
__ Television__ Periodical(s)/Serial(s) __ Slide Presentation
__ Video(s) __ World Wide Web
__Other (explain)____________________________________________________

Type of organization : _____ Non-Profit _____ Commercial

CONDITIONS

1. Possession of a Jewish Historical Society of Greater Hartford image does not constitute permission to use it. Permission must be requested using this form.
2. Permission is for one-time, one-project use only. The Society retains all rights to the images and they may not be used for any purpose other than that listed on the form. Any subsequent use—including subsequent editions, paperback editions, foreign editions, etc, constitutes re-use and must be applied for in writing. An additional fee may be charged.
3. Credit must be given to the Jewish Historical Society of Greater Hartford, and the creator of the work, if known.
4. Credit must appear with the image or on a credit page that indicates the page number and position on the page.
5. For archival materials the credit line must appear with the item or on a credit page, indicating the page number and the location on the page, for each item.
6. In visual media, e.g. films, slides, etc., credit must appear with other credits at the beginning or end of the production.
7. In a display or exhibition, please credit each image within the display or exhibition area.
8. Photos may be cropped to suit design and layout, but they may not be altered, colorized, or drawn upon without permission from the Society.
9. The Society reserves the right to decline permission to publishers and individuals who have not complied with these conditions.
10. A complimentary copy of each publication or production in which an item appears must be sent to the Society.
11. The user may not reproduce or permit others to reproduce the item or a facsimile of it. Additional copies must be requested.
12. All responsibility for possible copyright infringement is assumed by the user.
13. If the image is still under copyright and the copyright is not held by the Society, the requestor must seek permission from the creator of the work or from the current copyright holder. The Society will provide the creator’s name, if known.
14. All usage fees must be paid in full prior to the date of publication or broadcast.

The user assumes all responsibility for conforming with the laws of libel and copyright which may be involved in the use of these materials. Permission is granted for one time use only.

I have read and agree to abide by the conditions listed above.

Requested by: _____________________________________________
(please print)

Signature: _________________________________

Date:________________________

Approved by (authorized representative of JHSGH)

________________________

Title ________________________ Date _______________________

 

Please itemize each image or audiovisual material to be used. Include brief description of each image. Use fees will be determined from this listing. Use fees will not be refunded.

DESCRIPTION OF ITEM                                   BOX NAME & NUMBER

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