Copyright and Reproduction Form

Detailed description of the material requested(Required)

(Provide a list of material requested with a description and one or more of the following: title of the work, name of artist or author, year of creation or date of publication, any reference number, publication title and page, Web address (URL), etc.)

Information on material requested

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Intended use of the material requested

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Publication

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Title of publication

Territory of distribution

Exhibition

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Web use

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Required license duration (years)

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