This image is protected by copyright. For permission to reproduce this artwork from LACMA's permanent collection, please complete all fields in this form ( Do not leave a field blank, type "N/A" if needed.) Your Name * Address * City * State * Zipcode * Country * Phone * Fax * Email * Photo Material Required * B&W print color transparency digital image Date Photo Material Required * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20192020202120222023 Artwork Information Artist * Accession No. * Title * Date * Purpose and UsageFill in all fields pertinent to your publication. Do not leave a field blank, type "N/A" if needed. What is the title of the article/ magazine/ publication? Who is the author? Who is the publisher? What is the date of publication? How many copies will be printed? In which countries will the publication be sold/ distributed? In which language(s) will it be printed? Will the image appear in color or black and white? Will the image be used on the cover or inside the publication? Web UseFill in all fields pertinent to your publication. Do not leave a field blank, type "N/A" if needed. What is the title of the website? What is the URL of the website? How long will the image be on the website? Will the website be password protected? If password protected, how many subscriptions will you allow?