Permission to reproduce works				Reference #
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I give Museum Victoria permission to reproduce and use the works described below, for the intended use, described below.

Details of works to be reproduced by Museum Victoria	
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process.

MV. Id no.	Format / Description	

		

Details of Intended Use

Printed field guides and internet publications about nudibranchs, flatworms and other marine life

Future uses
I acknowledge that Museum Victoria may wish to publish, communicate or transmit the Works in the future for purposes such as exhibitions, publicity and education. 
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I / my organisation own(s) copyright in the Works 					Yes / No

I / my organisation is the exclusive licensee of the reproduction rights in the Works 	Yes / No

Copyright in the Works has expired							Yes / No

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I have the authority to sign this agreement, and to authorise the reproduction of the Works. I warrant that I have not entered into a conflicting agreement with any other party. I indemnify Museum Victoria for any loss or liability arising from a breach of this warranty.

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Museum representative:								Date __/__/__

Acknowledgment details 
Museum Victoria undertakes to ensure that ownership of copyright in the Works is acknowledged wherever 
possible and reasonable, unless it is authorised by the licensee/copyright holder or source to withhold
acknowledgment.

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