APPLICATION TO PUBLISH OR DISPLAY REPRODUCTIONS
OF ARCHIVAL MATERIAL

Name (please print): _________________________________________ Date: ________________

Address: ________________________________________________________________________

In accordance with the requirements of the LSUS Archives, I hereby request authorization to publish or display in facsimile the following items from the LSUS Archives. All items will be properly credited as specified in the form for Permission to Publish or Display Reproductions from LSUS Archives and Special Collections.

Item Description:














Bibliographical information on planned publication:





The University requests the following credit line in the publication or display:
LSU Shreveport Archives – Noel Memorial Library

LSUS Archives and Special Collections requests notification of publication or display and a complimentary copy of the published work.

I accept and agree to comply with the above conditions.

Signature: ___________________________________________________ Date: ______________