Image request

DATA CONTACT*

Name Surname

Job*

Company*

Phone*

Email*

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

REASON FOR THE APPLICATION*

PLACE OF THE PHOTO SHOOTS*

RELATING TO THE FOLLOWING SUBJECTS (provide the details to identify the subject):*

EQUIPMENT DETAIL*

MEMBERS OF THE TROUPE (if any)

Name	Surname

I DECLARE THAT PHOTOGRAPHS OR FILM FOOTAGE WILL BE USED FOR:**

strictly personal study or use (without publication, distribution and public sale)
scholarly use (paper or digital scholarly publication)
magazine or other printed material
printed or digital publication
DVD or video publication (for one edition)
web publication

WEBSITE DETAIL:*

Website title	URL/Domain

Circulation:

until 100.000 copies
over 100.000 copies

Online:

web edition of magazine without advertising purposes
web edition of magazine with advertising purposes

PUBLICATION DETAILS:*

Title	Type (book, exhibition catalogue, etc)	Publisher	Linguage

PUBLICATION DETAIL:*

Title	Type	Producer	Network or newspaper	Appearance numbers

Distribution:*

national
european (U.E.)
world

Circulation:*

over 1.500 copies
below 1.500 copies

Price:*

over € 77,50
below € 77,50
free distribution

PLACE OF THE PHOTO SHOOTS OR FILMING*

PLAN OF THE WORK (brief indication of contents, times and expected duration of filming):*

EQUIPMENT DESCRIPTION*

MEMBERS OF THE TROUPE (if any)

Name	Surname

THE FOOTAGE WILL BE USED FOR**

production for a TV broadcast
DVD production for sale (for one edition)
web publishing
advertising uses

DETAILS OF THE REQUEST*

To acquire high resolution digital images
To acquire low-resolution or black-and-white digital images
To obtain permission to reproduce images already in the applicant’s possession

RELATIVE TO THE FOLLOWING SUBJECTS (also specify the origin and other data required for the identification of the subject):**

I UNDERTAKE:
• to pay any sum due in advance;
• to use the images made exclusively for the stated purpose and for a single edition or print;
• to state the subject of the reproduction and its location in the edition and to expressly approve of the prohibition on any further unauthorised reproduction or duplication, in any way and by any means made;
• to include the following statement: “By permission of the Ministero della Cultura - Direzione Regionale Musei Lombardia”;
• to deliver a copy of the images made in high resolution digital format to the Photographic Archive of the Direzione Regionale Musei Lombardia or a copy of the video footage;
• to allow the Direzione Regionale Musei Lombardia to use the images or video footage for institutional purposes, with explicit indication of the source;
• to deliver three extracts or copies of the work or to communicate the web address;
• not to assign or transfer the concession granted on a non-exclusive basis;
• not to disclose, disseminate and or to the public copies made for strictly personal use or for study purposes;
• to accept all civil liability for any damage to persons, things and state property that may occur during filming.

The Ministero della Cultura is released from liability for any damage caused to the equipment and/or to people during the filming. Except for special agreements, photographic recordings of works being restored as well as, for two years, those restored or newly acquired are not permitted.

Consent*

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IMAGE REQUEST

To film video footage, conduct photo shoots or request a photo reproduction of the works in the Museum.