COPYRIGHT CLEARANCE FORM

Permission is hereby granted for

to reproduce the following material

in the project titled

I confirm that the nature of the project has been explained to me, that I/my organisation have the right and authority to enter into this agreement, and that the materials provided may be used in part or in full for the following (please circle yes or no for each purpose): YES/NO YES/NO YES/NO YES/NO within the project for the purposes of publicising, promoting and advertising the project in any media in any other project directly evolved from the project in any media in perpetuity within other associated projects as specified

The name of the person/organisation to be acknowledged is:

Name Position & Organisation Address

Phone Email Signature Date

Produced by the Powerhouse Museum, Sydney, with assistance from the New South Wales Government through its Environmental Trust.