Please print and complete this form and mail it to:

LHEF, Inc.
484 14th Street
Brooklyn, New York 11215


PHOTOGRAPHY/ART DONOR AGREEMENT
(for Special Collections and Oral Histories use separate forms)

Name of Donor: _______________________

Name of Photograph or Photography Collection: _______________________

Address: _______________________

_______________________________

City: ___________________________

State: _________    Zip: ____________

Date: _________


Phone Number: ____________

E-Mail Address: _____________
(if you would like to be informed of upcoming events)


Collection # _______________________________   (to be filled in by LHEF)

I agree to donate the material described below to the Lesbian Herstory Archives/Lesbian Herstory Educational Fund (LHEF, Inc.) to become its permanent property. All property rights of the material or objects donated are granted to LHEF. This material may be made available for browsing and research, subject to restrictions that may appear below.


Description of Material:

Identify the people and places/events depicted; indicate if unknown. Use space below and additional pages if necessary. Please be elaborate, we may have to rely solely on your information to identify these photographs. Please try to give us as much of the requested information as possible:

Name and address of photographer:

Place:

Date of photograph:

Event:


Please Indicate:

Any items in this collection not retained by LHEF (duplicate books or periodicals, for example) are to be (check one):

_______ Returned to the donor       _______ Disposed of at LHEF's discretion

Any copyright which the donor possesses to publish or reproduce this material in print, video, film, or other recorded format is reserved by the donor requiring written consent prior to each publication until death whereupon (check one):

      _______ It is assigned to LHEF, Inc.

      _______ Assigned at this time to LHEF, Inc.

      _______ Other (as stipulated below or on reverse)

LHEF (check one) may___ may not___ list my name and a general description this material on the LHA website. I understand that any restrictions that may appear below remain in effect.

I understand that all responsibility to obtain publication or reproduction permission rests solely with individual researchers, not with LHEF, Inc. Researchers may take photographs or make photocopies of this material for personal use instead of note taking.

LHEF, Inc. may/may not (circle one) provide researchers with my address and phone number for publication permissions.

The person/people in this photograph have/have not (circle one) agreed to let their images be published/reproduced.


Restrictions:
(Please use back of page if more space is needed).

Access to this material is restricted as follows:




Display of this material by LHEF is restricted as follows:





Donor Signature: _____________________________________



Received By: ______________________________________       Date:________    (to be filled in by LHEF)

LHEF, Inc. seeks material from all lesbians. Access to collections is granted without regard to academic, sexual, or political credentials. All donations are tax-deductible.

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