Applicant: ____________________________________________________________________

Address: ______________________________________________________________________________________________________________

Telephone: __________________________ Email: __________________________________

Applies for permission to reproduce:                             Color   B&W   InsideCover

___________________________________________ ______ ______ _____ _____

___________________________________________ ______ ______ _____ _____

___________________________________________ ______ ______ _____ _____

In the following publication/film:

Title: _________________________________________________________________________

Author: _______________________________________________________________________

Periodical Name: _______________________________________________________________

Publisher and Address: ______________________________________________________________________________________________________________

Expected date of publication, volume, year: __________________________________________

Check all that apply: _____ Commercial ____ Non Profit ____ Advertising

____ Book _____ Periodical ____ Dissertation ____ Textbook ____Film/Video _____ Exhibition Catalog ____Other: ______________

Distribution rights desired (one time use, one language)

North American rights ______ World rights ______ Language ______________________Other use:___________________

CREDIT LINE MUST READ: Courtesy of the Woodstock History Center

The applicant agrees that this permission is subject to the conditions listed on the back of this form and further agrees to promptly pay all applicable fees.

Signature of applicant: _________________________________________ Date: ____________

Print name and title: _____________________________________________________________

Signed for the Museum: ________________________________________ Date: ____________

Name and title: _________________________________________________________________


1. All requests for permission to reproduce an image for publication must be made in writing and include the intended use, the publisher, and expected date of publication.

2. The publisher is to provide the History Center with one complete, gratis copy of the publication/film in which the image is reproduced.

3. Reproduction is permitted only from prints or digital photograph files supplied by the History Center.

4. All negatives and digital photograph files remain the property of the Woodstock History Center.

5. Each image must be reproduced unaltered and in its entirety unless approved in advance by the Historical Society. The reproduction must not be cropped, bled off the page, printed on color stock or with colored ink, nor have anything superimposed on the image. When a detail is used, the word DETAIL, must appear in the credit line.

6. Full documentation credit must appear in immediate proximity to the image, or in the section devoted to photographic credits. Abbreviations are not permitted.

7. The Woodstock History Center assumes no responsibility for any royalties or fee claimed by the artist or photographer, or on his or her behalf.

8. The History Center reserves the right to deny permission to reproduce an image from its collection to any applicant whose product is not acceptable to the Society for any reason.

9. Permission is granted for one time use as detailed on the application form. Permission to publish must be obtained in advance for each subsequent edition or reprint.

10. Failure to pay the required fees for reproduction means that permission has not been granted.

11. Permission is valid only for the individual, company, or institution to whom it is specifically issued and may not be transferred, assigned, sold, or otherwise disposed of without written permission of the History Center.

12. In the case where copyright is held by a third party, written permission must be secured by the applicant from that party or their agent, and must accompany the application.

13. If so requested, a proof must be approved by the Woodstock History Center before reproduction of an image in color.

PROOF MUST BE APPROVED: ________ Yes _______ No