LibForms - Permission to Copy or Publish

Special Collections Permission to Copy or Publish

Complete this form if you need to request permission to copy or publish any materials from Special Collections & Archives in the McClay Library. Once submitted, your request will be reviewed and you will be contacted to confirm the request.

Contact Details

Forename:(*)

Please enter a valid forename

Surname:(*)

Please enter a valid surname

Address:(*)

Please enter a valid address

City/Town:(*)

Please enter a valid city or town

Postcode:(*)

Please enter a valid UK postcode

Mobile telephone number:(*)

Please enter a valid telephone number

Email Address:(*)

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Repeat Email Address:(*)

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Institutional Affiliation (Where relevant):

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Copy Request Details

Source of material to be duplicated:(*)

Please provide a reference to the item(s)

Do you intend to publish your work?(*)

Please choose an option from the dropdown

Item Description:(*)

Please provide an appropriate description

Resolution:(*)

Please provide the resolution of the item

Save as:(*)

Please provide the format of the copy

Publish Request Details

Proposed publication/website:

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Anticipated date of publication:

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If an article, please list the journal title:

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Please check category of intended use:

Publisher (and city):

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Country:

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Print run/Duration:

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Language:

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Approval status:

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I understand that this permission will be valid for this specified request only and applies insofar as Queen’s University Belfast, as owner or custodian, holds rights in the material, and does not remove the responsibility of the author, editor, and publisher to guard against infringement of any rights, including copyright, that may be held by others.

Further, I agree to cite the source of the material as Special Collections & Archives, Queen’s University Belfast, QUB reference where appropriate and to arrange that a gratis copy of the publication is deposited with Special Collections.