Please print and complete this form and mail it to:

LHEF, Inc.
P.O. Box 1258
New York, NY 10116

SPECIAL COLLECTION DONOR AGREEMENT
(for Art/Photography and Oral Histories use separate forms)

Name of Donor: _______________________

Name of Collection (if different from Donor's Name): _______________________

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 creator(s) of each item where relevant; indicate if unknown. Use space below and additional pages if necessary.

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 may/may not (cirlce one) list my name and a general description of the contents of my special collection 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.

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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