Request for Photographic Material

Please fill out the form below to begin the process for your request. To request more than three items, please fill out and submit another form. Please note that photographic material requests must be received two months in advance. For questions or further information, please contact images@thewolf.fiu.edu or 305.535.2628.

Current Date:

MonthJanFebMarAprMayJunJulAugSepOctNovDec

Day12345678910111213141516171819202122232425262728293031

Year20112012201320142015

Date materials needed by (MUST BE AT LEAST 1 MONTH FROM NOW):

MonthJanFebMarAprMayJunJulAugSepOctNovDec

Day12345678910111213141516171819202122232425262728293031

Year20132014

Name:

E-mail Address:

Institution:

Address:

City :

State:

Country :

Zip Code:

Phone Number:

Fax Number:

Purpose:

Reproduction

Research

Web Usage

Other

If Other, please specify:

Publisher (if any):

Title of the Publication:

Author:

Expected Date of Publication:

Other Publication Details:

(edition number, area of distribution, and languages to be used)

print run (# of copies):

Please record the number of copies that will be printed.

REQUEST 1

Accession Number:

Artist Name:

Title of Work:

Type of Work:

REQUEST 2

Accession Number :

Artist Name:

Title of Work:

Type of Work:

REQUEST 3

Accession Number :

Artist Name:

Title of Work:

Type of Work:

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