Consent* I have consulted with Director of Collections before filling out this form.Name* First Last Email* Phone*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Consent* I have read and agree to the following conditions Permission for duplication is based on the following conditions. 1) Any permission granted is for non-exclusive, one-time use only for any purpose unless mutually agreed and stated in writing. Such use is limited to one-time reproduction and further permission will be necessary for subsequent use. 2) The Wisconsin Maritime Museum follows the ethical and professional standards as prescribed by the American Alliance of Museums (AAM) and the Council of American Maritime Museums (CAMM). The Wisconsin Maritime Museum retains the right, in its sole discretion and at any time including post-production, to prohibit user from using and/or referencing information acquired directly or indirectly from the Museum. 3) If the duplicated material appears in a printed publication, film, video, electronic or digital media the user agrees to furnish at no cost to the museum at least two copies of the final product. 4) User agrees to provide adequate security to prevent theft, pirating, unauthorized exhibit, duplication, or copying of any materials obtained from the Wisconsin Maritime Museum. In the event of any unauthorized reproduction, the user will give prompt notice to the Wisconsin Maritime Museum. 5) Any unauthorized use by any person or entity, for any reason, will render the user responsible and liable to the Wisconsin Maritime Museum for appropriate compensation and other costs, regardless of whether applicant has profited or is responsible for such unauthorized use. 6) A credit line, as supplied by the Wisconsin Maritime Museum must appear in immediate proximity to the reproduction or in the section of the work devoted to acknowledgements. Abbreviations are not allowed. The credit line that must be used is the following: [Accession Number] Wisconsin Maritime Museum Collection. 7) The museum makes no warranties or representations and assumes no responsibility whatsoever for any claims against applicants by an artist, copyright holder, their agent, estate, or any other party in connection with the duplication of collection items. The user agrees to indemnify the Wisconsin Maritime Museum its employees, representatives, officers, and trustees and hold it harmless against any and all such claims, including copyright infringement claims, royalty or fee demands and/or actions, including the costs thereof, arising as a result of the users duplication of the work. 8) User shall obtain all necessary consents and waivers and/or make all payments that may be due any person, firm or corporation arising from the use of items. 9) Payment of all duplication work must be made in advance. Rates determined by the Wisconsin Maritime Museum and subject to change. I have read and agree to all the conditions for duplication as stated above.Electronic Signature*Signature / Parent or Guardian if Under 18By signing and submitting this online form, you agree to the disclaimer and release conditions listed above.Date* Date Format: MM slash DD slash YYYY Description of request (e.g., hi-res digital image, 8x10 print, etc)*Description of use (e.g., research, print publication, etc)*Distribution Type (If Applicable)Payment Amount:*Please enter a number greater than or equal to 1.Subtotal Price: $0.00 Credit Card* Card Details Cardholder NamePhoneThis field is for validation purposes and should be left unchanged. Submit This iframe contains the logic required to handle Ajax powered Gravity Forms.