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Application for the permission to publish of the Marciana National Library
Please send or fax the form below, filled in all its parts, to:
Marsilio Editori
3198, San Marco
30124 Venezia, Italy
FAX: +39 41 5223051
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To the Director of the Biblioteca Nazionale Marciana, Venezia
I, the undersigned (Name) ... ... (Surname) ... ...
(Date of birth) ... ... (Address) ... ... request permission to publishin the work (Author) ... ... (Title) ... ... (Publishing House) ... ... (Journal) ... ... the photographic reproduction of the following work(s):(Description, collocation, number of pages planned for publication, specifyingif B/W or colour) ... ...
I, the undersigned, declare that as for now:
- I agree to supply to the Library, free of charge, with at least onecopy or an extract of the published work;
- I agree to cite in the caption all the elements that permit the identificationof the work, following the instructions provided by the Library;
- the print run of the work will be of ... ... copies and the market pricewill be set in Italian Lire at the price of ... ..., or (if this is thecase) it is a scholarly journal.
All messages concerning this permission will be sent to the following address:
(Complete address, zip code, city, state, e-mail) ...
(Place and date) ...
(Signature) ...------------------ (cut here) ------------------
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