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GHPL: Donor Permission Form, p. 1

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Donor Permission Form Grey Highlands Public Library Digitization Project Jessica Posgate Digitization Project Facilitator (519) 986-3436 Reproduction Permission Form Name: ______________________ Phone: Address: ______________________ Email: ______________________ _______________ _______@________ I, _____________________, hereby permit the Grey Highlands Public Library to digitally reproduce and display the items listed below on the Internet. In granting this limited permission, I do not surrender any of my rights to these materials, but allow fair use of the digital reproductions for personal study and not-for-profit educational uses. Item No. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 __________________________ Signature of donor __________________________ Signature of GHPL Library _______________ Date _______________ Date Description of item Original format of item

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