Media Image Request Step 1 of 2 50% REQUEST FOR USE: PHOTOGRAPHY, DIGITAL IMAGE(S)/FILM/VIDEO FOOTAGE §I - Usage InformationCompany*Email* Phone*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country I am requesting the following for use:* Images B-Roll Subject Matter of Desired Image(s)*Subject Matter of Desired Image(s)*Intended Use*(Please note that this photography/digital image(s)/film/video footage must be used to put Virginia tourism in a favorable, positive portrayal only and will cause those viewing to want to visit Virginia.)Deadline MM slash DD slash YYYY If there is a deadline for this request, please state here. Anticipated date/time period that requested images will be used: Begin Date* MM slash DD slash YYYY End Date* MM slash DD slash YYYY must be equal to or later than start date §II- Usage AgreementNote: Mismatched borrower name, dates of use, and company in Section 2 may delay approval.VIRGINIA TOURISM CORPORATION Photography/Digital Image(s)/Film/Video Footage Usage Agreement This agreement is between the Virginia Tourism Authority d/b/a Virginia Tourism Corporation, a public body corporate and political subdivision of the Commonwealth of Virginia, hereinafter known as VTC, andBorrower Name*whose name appears below hereinafter known as the Borrower, and provides for the lending to the Borrower and the usage of the photography/digital image(s)/film/video footage subject to the terms and conditions of this agreement for the periodBegin Date* MM slash DD slash YYYY End Date* MM slash DD slash YYYY A. VTC retains all exclusive rights of ownership of photography/digital image(s)/film/video footage loaned to Borrower. B. VTC agrees to loan and allow Borrower to use the photography/digital image(s)/film/video footage requested in this REQUEST FOR USE OF PHOTOGRAPHY/DIGITAL IMAGE(S)/FILM/VIDEO for the use only as requested and approved in this request for the period listed above. Any other intended use by Borrower or use longer than time period listed above shall require VTC’s written approval. C. VTC represents that it has the right to grant the use of the photography/digital image(s)/film/video footage to Borrower and will not infringe on the rights of any third party. D. Borrower shall use this photography/digital image(s)/film/video footage only for the purpose indicated in this REQUEST FOR USE OF PHOTOGRAPHY/DIGITAL IMAGE(S)/FILM/VIDEO FOOTAGE and only to put Virginia Tourism in a favorable, positive portrayal (which may cause viewers to want to visit Virginia). E. Borrower shall not authorize others the use of this photography/digital image(s)/film/video footage without VTC’s prior written approval. F. With the exception of film/video footage, borrower shall not alter, manipulate, or derive from the photography/digital image(s) without written approval of VTC. Borrower shall not place the photography/digital image(s)/film/video footage in any electronic cataloging or electronic delivery service without the written approval of VTC. G. Borrower shall delete, destroy, or remove image/footage files from any storage medium after project is complete. Borrower agrees to furnish one tear page, pdf file, copy of publication, or produced video in which the photography/digital images/film/video footage appear. H. With the exception of film/video footage, borrower shall return photography/digital image(s) files or CD discs (if requested), safe and undamaged by airfreight, private courier, or registered Express Mail. I. Credit Line: With the exception of film/video footage, borrower shall accompany editorial use with adjacent credit line. Photographs are to be credited to the photographer where indicated. Borrower shall identify each subject published and its location in Virginia. If using photography/digital image(s), credit to the Virginia Tourism Corporation is not required, but appreciated. For use of film/video footage, Borrower shall include a credit in the end titles to thank the Virginia Tourism Corporation for use of archived footage (if applicable). J. Borrower agrees to indemnify, defend and hold harmless the VTC, its officers, agents, and employees from any claims, damages and actions of any kind or nature, whether at law or in equity, arising from or caused by the use of this photography/digital image(s)/film/video footage furnished to Borrower, provided that such liability is not attributable to the sole negligence of the VTC. IN WITNESS WHEREOF, the parties have caused this contract to be duly executed intending to be bound thereby.Requestor:*Company:*Request Date:Consent* I agree to the terms and conditions outlined above.By checking above and submitting this request form, you agree to abide by the use of VTC image assets and the terms and conditions outlined in sections 1 and 2 above, respectively. Δ
