(the "Owner") has received the request of (the "Requestor"), in a letter dated , to reproduce the Image(s) (as defined below). The Owner grants the request on the following terms, and the Requestor agrees as follows:

1. The images described below (the "Image(s)") are the subject of this agreement:

• Author:
• Title:
• Date:
• Medium:
• Dimension:

The Owner is the copyright holder of the Image(s). 

2. The Requestor has already obtained a reproducible copy of the Image(s).The Owner shall provide a color printblack and white printcolor transparency35 mm slideelectronic version  of the Image(s) from which the Requestor can produce the Image(s) for the purposes described below.

3. The Requestor may use the Image(s) as follows: . 

4. The Requestor may use the Image(s) in a seminar or other educational activity without restriction.only as follows: .

4.5. As consideration for the grant of the Owner's permission to reproduce the Image(s), the Requestor shall pay to the Owner a one-time fee of (the "Fee"). The permissions granted under this agreement are ineffective until the Fee is paid in full.

5.6. This agreement provides nonexclusive  worldwide English language rights, for this volumeissueedition only.

6.7. Every copy of the Image(s) used must include, either on the copyright page or below the Image(s) themselves, the following credit line: . If the copyright and acknowledgment notices are not printed as specified, all permissions granted by this agreement are canceled without further notice.

7.8. The Owner makes no representations about the Requestor's use of the Image(s). More specifically, the Owner has not obtained any releases covering the Requestor's use of the Image(s) and the Owner does not represent that the Requestor's use of the Image(s) will not infringe the rights of any third parties. The Requestor shall indemnify the Owner from any claims, damages, liabilities, losses, or expenses (including reasonable attorneys' fees) that may arise out of the Requestor's use, reproduction, or distribution of the Image(s).

8.9. This agreement will terminate automatically if the volumeissueedition is not published within years from the date written below. In addition, the Owner may terminate the agreement at any time on days' notice, or immediately if the Requestor does not comply with any term of this agreement.

9.10. On termination of the agreement, all rights granted under this agreement, including the Requestor's right to use the Image(s), will end. The Requestor shall promptly discontinue its use of the Image(s) and may no longer reprint, publish, or distribute the volumeissueedition. However, the Requestor will have an additional years from the time the permission terminates within which to sell existing copies of the volumeissueedition. However, if the termination of permission is caused by the Requestor's violation of any provisions of this agreement, the Requestor may not sell any additional copies of the volumeissueedition.

10.11. The laws of the state of govern this agreement, (without giving effect to its conflicts of law principles).

11.12. The Requestor shall furnish to the Owner one complimentary copy or tear sheet for each publication, except motion pictures, in which reproduced Image(s) appear, on or before publication of the reproduced Image(s). If permission has been granted for electronic reproduction, the Requestor shall furnish the Owner with the internet or other electronic address at which the reprinted Image(s) will appear.

12.13. Nothing in this permission conveys any intellectual property rights or other interests to the Image(s), and the Requestor may not reproduce, distribute, sell, or transfer all or part of the Image(s). The Owner retains its own right to publish the Image(s), or to grant permission for others to publish the Image(s). The permission granted in this release is neither severable nor transferable to a third party. Any attempted transfer is void and of no effect.

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Each party is signing this agreement on the date stated opposite that party's signature. 

			Date:_____________________				By:____________________________________________________
							Name:  Title:
			Date:_____________________				By:____________________________________________________
							Name:  Title: