Special Issue Artwork Submission Form

This Permission covers original artwork (photography, digital design, or well-rendered photographs taken by me of my own painting, drawing, sculpture, ceramics, printmaking, or textile/fiber art) that I have submitted to the Wisconsin Medical Journal (WMJ).

In consideration for publication of my artwork in the WMJ, I grant to the Board of Regents of the University of Wisconsin System (UW) and the Medical College of Wisconsin, Inc. (MCW), nonexclusive permission to use, edit, publish, reproduce, distribute, and otherwise disseminate the artwork for their educational, research, commercial or promotional purposes, in any media including websites, print, radio, television, or other existing or future-developed media.

I hereby represent and warrant I am the sole creator and owner of the artwork, that the artwork is my original work, that I have full power to grant the rights above, and that the artwork does not infringe on upon any copyright, proprietary, privacy, personal, or any other right of any third party. I agree to indemnify and hold harmless UW and MCW, and their successors, assigns, and licensees, from and against any and all claims, costs, and expenses, including attorney’s fees, arising out of any breach of the foregoing warranties or representations.

I understand and agree that I will be credited as the artist in any use of the artwork by UW or MCW, and that I will not receipt compensation for any use of the artwork by UW or MCW in connection with the WMJ, nor have the right to edit or control its use.

This Permission does not obligate UW and MCW to publish my artwork in the WMJ. If my artwork is not published, this Permission shall be null and void.