Duplication And Use

Agreement To Permit Duplication And Use Of Copyrighted Works

________________ , a corporation/individual located at ________________ , as the copyright holder, or with the authority to act on behalf of the copyright holder, hereby grants Baptist Bible College & Seminary, for its ________________ department, located at ________________ , permission to duplicate and use the following material according to the following terms:

Title: ____________________________________________________

Author/Editor: _____________________________________________

Page #s/frame #s: __________ Year of Copyright: ___________

Periodical: ________________________________________________

Date of Periodical: ________ Volume: __________

Color and style: ____________________________________________

Print size: _________________________________________________

Period of intended use: _______________________________________

Date of first use: ____________________________________________

Material is to be sold: ________________________________________

To cover costs: ________ To exceed costs: ________

Payment due (if any) ________________________________________

Method of Reproduction:
_____ negative microfilm
_____ photocopy
_____ positive microfilm
_____ binding
_____ photo prints
_____ reader/printer
_____ ditto
_____ typeset
_____ offset
_____ (other)

Types of material to be reproduced:
_____ Audiovisual works (including motion pictures)
_____ Dramatic works
_____ Script
_____ Script with accompanying music
_____ Literary works
_____ Musical works (includes words)
_____ Pantomime and choreographic
_____ Pictorial or graphic
_____ Sound recording
_____ Scholarly work

Use to be made of duplicated materials:
_____ Research
_____ Teaching
_____ For distribution
_____ Not for distribution

Visual art works
For works of visual arts, 17 United States Code 106A provides the artist with certain rights of attribution and integrity independent of copyright. The artist who created the work(s) described above hereby exercises those rights as follows:

1.[ Insert any provisions related to attribution or other recognition of the artist ]
2.[ Insert any provisions related to modification of the work if modification is required for the use described above. E.g., artist may want to review and approve of a poster or shirt on which her artwork is printed, or artist may feel the description of the use above is sufficiently detailed to allow her to approve of that specific modification, if it is a modification, without further review. ]

Agreed to By:

Copyright Owner signature: _____________________________________ Date: _________

Printed Name: ________________________________

Artist signature (if different from copyright owner): _____________________________________ Date: _________

Artist printed name: ________________________________________