Louis Armstrong House Museum - Photo Request Form

Photo Request Form

Before submitting this form, please read our Photo Use Policy, available to download as a PDF file. (You need to have Adobe Reader installed to view PDF files.)

Your Information

First Name: *

Last Name: *

Organization: *

Address/Line 1: *

Address/Line 2:

City: *

State/Province/Territory: **

Zip/Postal Code: **

Country: *

Phone: *

Fax:

Cell Phone:

Email: *

PHOTO INFORMATION

List the accession number of the photo(s), or give detailed description(s): *

USAGE INFORMATION

Name of publication/broadcast/exhibit: *

Date(s) of publication/broadcast/exhibit: *

Approximate circulation/audience: *

Sale price/admission fee for publication/exhibit:

Please tell us more about the project, such as inside or cover use, language editions, one country rights or world rights, or anything else you think we should know: *

How did you hear about the Louis Armstrong House Museum: *

*Required
**Required if Country is USA or Canada