The Institute of Maritime Research and Discovery
Image Reproduction Application

Name of Applicant:
Organization:
Address:



Catalogue number or description of IMRD's image:

For Publication in:
Non-Profit Publication ______
Commercial Publication ______

Other, please specify:
Author:
Title:
Publisher:
Expected publication date:


Publication rights requested for:
One Country ______
Global ______
Personal use only ______


When this form is returned, you will receive an invoice for fees and a letter of permission, with citation instructions, to reproduce the image(s). Reproduction permission is contingent upon payment and assurance that two copies of the product in which the image(s) is used will be sent to IMRD without charge.

Date:

Signature of Applicant: