Organization Name: ____________________________________________________________

Authorized Representative: ___________________________________________

Address:_______________________________________________________________________

City: _________________________State/Zip: ____________Country: ______________

Phone: ________________________________ Email: ______________________________

Scope and subject of request:

_____________________________________________________________________________

______________________________________________________________________________

Type of organization: Media Publisher NonProfit Other (indicate below)

_____________________________________________________________________________

The organization named above and its employees, agents, and assigns (hereafter, "the organization") agree to adhere to the following terms under which materials from the Chicago Jazz Archive are provided for non-academic use and publication.

If making an onsite visit, the representative of the organization named above has read the Chicago Jazz Archive's website documents Visiting the Archive and Visitor Guidelines, and agrees to abide by the procedures and terms stated therein.

This agreement gives the organization permission to copy and use Chicago Jazz Archive print and image materials only for the specific project or use stated. It does not grant permission to further publish or reproduce CJA materials for any other use, nor does it grant permission to transfer possession or use of CJA materials to other parties.

It is understood that the Chicago Jazz Archive and the University of Chicago Library may not be the holders of the copyright, literary, or performance rights to material examined or copied from Archive collections. The organization agrees to accept all responsibility for obtaining any necessary permissions from the holders of the rights in Archive materials used by it, and to assume all responsibility for any infringement of copyright, literary, performance, or other rights, as well as accruals of royalties, that may result from the organization's use of Archive materials.

The organization agrees to credit the Chicago Jazz Archive for materials and assistance rendered in the course of the project. Before quoting, publishing, reproducing or performing from Archive materials the organization agrees to obtain and use the correct credit line for any materials obtained from the Chicago Jazz Archive's collections.

The organization agrees to make arrangements for and pay for all reproduction, postage, and other costs related to delivery of requested materials to the organization.

It is understood that due to copyright restrictions, the Archive cannot provide copying services for media materials in its collections. It is further understood that the Archive does not have the facilities to do professional quality photography and cannot do design work, nor email scans of the size and quality necessary for prepress and subsequent publication.

Should reproductions of images or print materials be required, the organization agrees to make reproduction arrangements with the Library's Special Collections Research Center, or to contract and pay a third party to make reproductions of such paper materials under the supervision of the Archive Curator. Such third parties are agents of the organization for the purposes of this agreement, and are subject to the same reproduction restrictions, especially those concerning transfer of CJA materials to other parties. The organization agrees that its employees and agents will not keep personal copies of Archive materials.

The organization agrees to make arrangements for and pay for all reproduction, postage, and other costs related to delivery of requested materials to the organization.

It is understood that commercial reproduction of selections from oral history materials is usually prohibited by the agreements under which the interviews were recorded. On rare occasions special permission from the holders of the rights can be arranged on a case-by-case basis. The organization agrees to hold the Chicago Jazz Archive harmless if permission to use oral history materials cannot be secured.

Items requested, Archive location, and format:

_____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________

I hereby state that I am empowered to agree to and sign this agreement on behalf of

______________________________________________________________

In my capacity as ___________________________________________ for the organization.

I hereby agree and bind the organization to the terms of this agreement.

Date:

Signed:__________________________________