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Application to Publish

APPLICATION TO PUBLISH OR DISPLAY REPRODUCTIONS
OF LSUS NORTHWEST LOUISIANA ARCHIVAL MATERIAL

Name (please print): _________________________________________ Date: ________________

Address: ________________________________________________________________________

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

Item Description:

 

 

 

 

 

Please describe intended use:

 

 

The University requests the following credit line in the publication or display:
LSUS Northwest Louisiana Archives, Noel Memorial Library

LSUS Northwest Louisiana Archives requests notification of publication or display and a complimentary copy of a published work.

I accept and agree to comply with the above conditions.

Signature of applicant: ______________________________________ Date: ______________

LSUS Northwest Louisiana Archives hereby authorizes the publication or exhibition of reproductions identified on the foregoing application.

Signature of Archivist: ______________________________________ Date: ______________