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Email
*
First Name(s)
*
Last Name(s)
*
Organization / Institution
*
Role / Title
*
Phone (optional)
Website
*
Artwork / Image Requested
Title of Work:
*
Year of Work:
*
Medium (if known):
Image reference or link (if applicable):
Intended Use
Please indicate how the image will be used:
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Exhibition catalogue
*
Exhibition wall text / didactic panels
Press / media release
Website or online exhibition
Social media
Academic publication
Archive / internal reference
Other: _______
Distribution Details
Format(s):
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Print
Digital
Both
Estimated print run (if applicable):
Geographic distribution:
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Local
National
International
Duration of use:
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One-time use
*
Ongoing / permanent online
Fixed term: _______
Additional Notes
Usage Agreement
By submitting this request, I confirm:
The image will be used only for the stated purpose.
There is no sublicensing or resale of the image.
Proper credit will be given to the artist and rights holder.
Any additional use will require new permission.
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I agree to these conditions
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