Application for the release of photographic and video reproductions of the Archive for personal use or for study purposes

Name *

Surname *

Address

Street address

Postal Code

City/Town

Country

Tel./Phone

Email *

having read and accepted the Regulations, ask

Photographic reproductions black and white

Photographic reproductions in colour

Videos

of the following site (s):

Location

Author / Place / Time

Subject

Title

Inventory No.

No. of negative

Slide No.

Digital File No.

For personal use

For the following study reasons:

having read and accepted our Regulations;

he/she undertakes not to use the image thus obtained in any other way, except after having made an explicit request and having paid the due fees

and authorizes VIVE to use these personal data exclusively for the purpose of processing this application.