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Permission to Publish/Reproduce Images, Recordings and Interviews

Document Number: ADM-8767-E

Description: This form is used to request permission for the right and license to copyright, reproduce an/or publish in print, broadcast electronic or other media, photographic images, video and audio recordings, and/or interviews and to make derivative works of the images, recordings and interviews and use them for any such purposes. In addition, it can also be used to record, edit and publish a video and/or reproduce written or oral quote(s) and copyrighted or trademarked material.

Comments: Form is protected from modification and enabled for form fill (includes tabbed fields for form completion).

Content Contact: Central Forms Unit

Document Attachment:

ADM-8767-E (English Electronic Version - pdf/657 KB)

ADM-8767-E-S (Spanish Electronic Version - pdf/96 KB)

Note: If you need this form in an alternate format, please send a message to the Content Contact listed above.