SPECIAL COLLECTIONS, CARRIER LIBRARY, MSC 1704 JAMES MADISON UNIVERSITY, HARRISONBURG, VA 22807 Phone 540-568-3612; Fax 540-568-3405; Email library-special@jmu.edu

APPLICATION TO QUOTE OR PUBLISH FROM COLLECTIONS

This form may be completed and submitted online; or printed out, completed, and mailed to the address above. Signed approval or further questions will be sent back to you. Fields in RED are required.

NAME:	DATE:
EMAIL:

PERMANENT ADDRESS:

PHONE:

INFORMATION ABOUT THE PROPOSED PUBLICATION IN WHICH QUOTE(S) IS(ARE) TO APPEAR:

TITLE OF BOOK OR ARTICLE

PUBLISHER OR PERIODICAL NAME

ANTICIPATED PUBLICATION DATE

MATERIAL FOR WHICH PERMISSION TO PUBLISH IS SOUGHT (give specific collection titles and numbers and identify specific parts of these collections):

AGREEMENT: By signing this application, the applicant agrees to the following conditions: 1) to use the material cited above ONLY in the specific publication named above; 2) to give credit in footnotes and bibliographies, and to give it in the following form: (Name of Collection), James Madison University Library, Harrisonburg, VA, 22807 (if collection is owned by the Harrisonburg-Rockingham Historical Society, this must be stated); 3) to expressly assume all responsibility for observing applicable laws of copyright and libel and to exonerate, indemnify and hold the University and its agents harmless for all loss, cost, damage or expense arising in any way connected with the use of the material identified above; 4) to provide the University two (2) copies of the published work in lieu of publication permission fees.