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Media and Image Application
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* Indicates required question
Applicant Information
Name
*
Your answer
Company
*
Your answer
Email
*
Your answer
Phone
*
Your answer
Mailing Address
*
Your answer
Billing Address
*
Your answer
Object Information
Artist/Maker
Your answer
Title of Work(s)/Exhibition
Your answer
Medium
Your answer
Accession Number
Your answer
Additional Information
Your answer
Publication Details
(Working) Title
Your answer
Author/Editor
Your answer
Author/Editor/Director/Producer/Designer
Your answer
Publisher
Your answer
Print Run/Term Length
Your answer
Language(s)
Your answer
Publication/Release Date
Your answer
Image Placement
Interior
Cover
Timeline
Image Deadline
Your answer
Rush Order
*Involves additional fees
Yes*
No
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Specific Use
Research (NOT for reproduction)
Commercial (for reproduction)
Nonprofit/Scholarly (for reproduction)
Book/Catalogue
Magazine/Journal
Textbook
Merchandise
Website/Internet use
Exhibition promotion
Education materials
Television broadcast/Film/Video
Other:
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