I hereby notify Washington University Libraries' Department of Special Collections of my intent to quote from or publish the following materials that are part of the Special Collections: (State specifically and in detail the manuscript materials or portions of manuscript material you intend to quote from or publish. If any images or transcriptions of manuscript collection materials are to be used as illustrations, provide an itemized list. Use an attached sheet if necessary.)

Please provide the publication information listed below:

Author/Editor:	Title:	Publisher:
Projected publication date:	Print run:	Projected retail price:

Conditions governing publication of Washington University’s Special Collections manuscript material:

1. Permission to conduct research with Special Collection’s manuscripts, either on-site or through copies, entails an obligation that a patron complete and return this "Notification of Intent to Quote from or Publish Manuscripts" form before quoting from or publishing Special Collections manuscripts.
Publish means quotation in whole or in part in seminar or term papers, theses or dissertations, journal articles, monographs, books, digital forms, photographs, images, dramatic presentations, transcriptions, or any other form prepared for a limited or general public.
2. Publication can take place only under the provisions of the fair-use doctrine in the U.S. Copyright Law (as amended) or by obtaining permission of the copyright holder, which in some instances may be Washington University.
3. The Department of Special Collections reserves the right to assess a use fee for publication of reproductions of items held in its collections. Publication of a reproduction may require the additional permission of copyright holder(s) or executor(s), and Washington University may require patrons to demonstrate that they have obtained appropriate permissions before providing publishable reproductions of copyrighted items. Unless otherwise specified, permissions to publish reproductions made from items owned by the Department of Special Collections are granted for one-time, non-exclusive, single-edition rights only.
4. The Department of Special Collections reserves the right to assess a use fee for any form of publication of manuscript materials where Washington University is the copyright holder. Publication may also require permission of additional copyright holder(s) or executor(s). Unless otherwise specified, permissions to publish from Washington University are granted for one-time, non-exclusive, single-edition rights only.
5. Published work created using manuscript collection materials from Washington University Libraries must include a citation in the following form: Name of the Collection, Washington University Libraries, Department of Special Collections
6. The Department of Special Collections requires that a complete copy of any publication (in any medium) that is based on its materials be given to the Department for its collections.
7. THE PATRON WILL DEFEND AND HOLD HARMLESS (1) WASHINGTON UNIVERSITY, ITS WASHINGTON UNIVERSITY LIBRARIES AND DEPARTMENT OF SPECIAL COLLECTIONS, ITS BOARD OF TRUSTEES, ITS OFFICERS, EMPLOYEES, AND AGENTS, AND (2) THE COPYRIGHT OWNERS, THEIR HEIRS, SUCCESSORS, AND ASSIGNS AGAINST ALL CLAIMS, DEMANDS, COSTS, AND EXPENSES INCLUDING ATTORNEYS' FEES INCURRED FOR ANY AND ALL CLAIMS OF COPYRIGHT INFRINGEMENT OR ANY OTHER LEGAL OR REGULATORY COURSE OF ACTION ARISING FROM PATRON'S USE OF SPECIAL COLLECTIONS MANUSCRIPT MATERIALS.

STATEMENT OF RESPONSIBILITY: I certify that the information on this form and any attachments is correct and that any publication of the requested materials will meet the conditions established by the Department of Special Collections, as listed above. Further, I am aware of my responsibility in the case of possible copyright infringement.

Curator:
For WU-Dept. of Special Collections Use