Image and Video Release Form
Artist’s Name & Address
Copyright Holder’s Name & Address
(if different from artist)
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Title(s) of Illustration(s) or Video
Artwork(s):_________________________________________________________
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Medium: ____________________________________ Date of Execution: ___________________
Original Dimensions (if Applicable): __________________________________________________
Photographer, videographer, or other credit line: ____________________________________________________
(Please indicate: Was photo taken or video shot as work-for-hire? Yes _____ No _____)
I hereby grant to Leonardo/ISAST, Museum of Contemporary Cuts (MoCC), and National Museum of
Contemporary Art, Athens (EMST) nonexclusive worldwide rights to reproduce and/or exhibit the above-mentioned
Illustration or Video Artwork in Leonardo/ISAST’s publication Leonardo Electronic Almanac (LEA) and on
MoCC’s and EMST’s website and on physical spaces for the purpose of art exhibitions. I understand that this
permission includes reproduction in any and all media now known or hereafter discovered, including but not limited
to print, electronic online databases and the World Wide Web. This also includes licensing the LEA Article for
document delivery.
I certify that I am the copyright holder of the above-mentioned Illustration or Video Artwork. I understand that (1) I
will retain copyright to the above Illustration or Video Artwork, and (2) my copyright will be prominently displayed
next to any reproduction of the above artwork along with any credit line included above. I agree to indemnify
Leonardo/ISAST, MoCC, and EMST against any claim or action alleging facts which, if true, constitute a breach of
any of the foregoing warranties.
Please sign, date and print names clearly.
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Artist or Copyright Holder (print name)
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Photographer or Videographer (print name)
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Artist or Copyright Holder signature/date
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Photographer or Videographer signature
date
(Signature required unless photo was
taken as work-for-hire)
Concerning Promotional Material: If you do not wish to give LEA and/or its publisher, Leonardo/ISAST, MoCC,
and EMST permission to use your Illustration(s) in promotional material, please initial this space ____.
* Please use back of sheet or make additional copies of form as needed.
Please return signed form to LEONARDO. Fax: 510-858-7548; email: <[email protected]> or post:
LEONARDO, 1440 Broadway, Suite 422, Oakland, CA 94612, U.S.A.
(August 2016)