PHOTOGRAPH ORDER FORM

Please complete this order and submit to The Secretary, Kurrajong-Comleroy Historical Society, PO Box 174, Kurmond, NSW, 2757, Australia, for reprints of any photograph required from the Society's image archive. For each photograph required place an "X" in the box below to indicate B&W or colour (which also includes sepia) and include the photograph's identifying number from the archive as well as the quantity of each required. To print the blank order form click here. (If space is insufficient print off additional forms). Photos will be printed on A4 size paper.

 

Costs for each reprint are as follows: Black & white $8, Colour $12.

For each order add $4 postage and packing within Australia or $10 for postage overseas.

 

 

Photo Number Quantity B&W Colour Total Cost
        $
        $
        $
        $
        $
Total cost (including $4 postage within Australia or $10 for postage overseas): $

 

 

Cheques should be made payable to Kurrajong-Comleroy Historical Society and be included with this order.

  1. I/We declare that the above ordered photograph(s) will be used for:

    •  Private research or study.
    •  For purposes other than private research or study.
    (Cross out whichever is inapplicable).

  2. If the above ordered photograph(s) are required for purposes other than for private research and study then I/We have completed the Permission Request obtained by clicking here and will submit this with my/our order.

  3. I/We understand and agree to the following conditions with respect to the use of the photograph(s):

    •  Compliance with the requirements of the Copyright Act 1969 (Cwlth) and the Copyright Amendment (Digital Agenda) Act 2000 (Cwlth) is my/our responsibility and the Kurrajong-Comleroy Historical Society will not be held liable for any breach by me/us under these Acts regarding use of the photograph(s); and
    •  Factual details included with the photograph(s) supplied by the Kurrajong-Comleroy Historical Society are done so in good faith and the Society does not guarantee the accuracy of such information.

    Signed .......................................................................       Date ..............................................

    Print name(s) ..........................................................................................................................

    Postal Address .........................................................................................................................

    Telephone ..................................................       Email .............................................................