Permission Form


The Walter Havighurst Special Collections, Miami University Libraries
151 S. Campus Ave., Oxford OH 45056
Please complete and submit the form below; you will receive an e-mailed copy of the request. If you prefer, you may also download, print, complete and mail in the Publication Request Form (online form preferred).Name:
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Confirm: I hereby request permission to publish, or cite material in the collections of the Walter Havighurst Special Collections. I understand that this permission grants one-time, non-exclusive United States and world rights to publish the item(s) listed below (1), and in the manner specified (2). The material will be cited or credited: From the Walter Havighurst Special Collections, Miami University Libraries, Oxford, Ohio.Material or item(s) to be published or cited (indicate one and whether whole item or part, including page numbers, paragraphs, etc.):Information about your forthcoming publication (title, author, publisher, publication date, edition, etc.):I understand that the Walter Havighurst Special Collections, Miami University Libraries may not be the copyright holder of the materials I wish to publish. I understand and agree it is my responsibility to obtain any and all necessary permissions from the copyright holder(s).In requesting permission to publish a copy of the item or items described above, the undersigned agrees to indemnify and hold harmless the Walter Havighurst Special Collections, Miami University Libraries from any action relating to infringement of the rights of any person or entity who may claim legal rights in these item or items under common law or under statutory copyright. These persons or entities may include, but are not limited to, authors, editors, contributors, designers, illustrators, photographers, photographic subjects, artists, printers, publishers, and binders, or their heirs, successors, and assigns.Permission to Publish Agreement

I agree to the conditions for publishing material from the Walter Havighurst Special Collections, Miami University Libraries, as outlined in the above policy. By entering your name below it will be used as an electronic signature. You will also have the option to sign the form that you will receive as a confirmation email, if you prefer: