American Geographical Society Library
The University of Wisconsin-Milwaukee Libraries
2311 E. Hartford Ave., Milwaukee, WI 53211
Telephone: (414) 229-6282 --- Fax: (414) 229-3624
Email: agsl@uwm.edu

Permission for Reproduction of Materials Form

I request permission to reproduce the following item(s), property of the American Geographical Society Library at the University of Wisconsin-Milwaukee Libraries.

Author: ________________________________________________________________________________________
Title: __________________________________________________________________________________________
Date of Publication: ______________________ Call Number: ______________________________________________

Type of Material (circle one):
Map _____
Book _____
Atlas _____
Photograph _____
Other _____________
Type of Reproduction (circle one):
Photograph-- size:___________
Color Slide _____
Black & White slide _____
Select preferred format:    jpeg ___          tiff ___            pdf ___          other (please specify)_____________

Conditions:

  1. All responsibility for questions of copyright that may arise in the use made of reproduced material provided by the AGSL must be assumed by the user.
  2. No exclusive rights for the use of AGSL material will be given.
  3. One-time reproduction rights are approved. If future reproductions are desired, written permission must be obtained each time.
  4. All reproductions of material intended for publication or similar use must be obtained directly from the AGSL, which reserves the right to examine a copy of reproduction before printing.
  5. The cost for preparation will be covered by the requesting party. Negatives or slides will remain the property of the AGSL and must be returned to the AGSL after use.
  6. The AGSL reserves the right to limit the number of items to be copied and to refuse permission to copy material, especially if damage of the materials could result.
  7. It is agreed that this material will not be used for profit.
  8. Special contractual procedures are required for reproduction and use of AGSL material for profit. Payments will be subject to negotiation and mutual agreement.
  9. A credit statement, which is clearly visible, will read: "From the American Geographical Society Library, University of Wisconsin-Milwaukee Libraries." This credit statement must be used, whether or not the AGSL material is being used for profit.
  10. A complimentary copy of the book, periodical, or other printed material in which the AGS Library item appears will be donated to the AGSL.
  11. This reproduction will be used for: ________________________________________________________________

Patron's Name: __________________________________________________________________________________
Address: ________________________________________________________________________________________
Signature: ____________________________________________________________ Date: _____________________

Staff Use Only

Reproduction Authorized By: ______________________________________________________________________
Date Material Returned (if applicable): __________________________________________________________________
Material's Condition When Returned (if applicable): _______________________________________________________

 

April 2013