Outdated or Unsupported Browser Detected
DWD's website uses the latest technology. This makes our site faster and easier to use across all devices. Unfortunatley, your browser is out of date and is not supported. An update is not required, but it is strongly recommended to improve your browsing experience. To update Internet Explorer to Microsoft Edge visit their website.
Document Number: ADM-8767-E
Description: This form is used to request permission for the right and license to copyright, reproduce an/or publish in print, broadcast electronic or other media, photographic images, video and audio recordings, and/or interviews and to make derivative works of the images, recordings and interviews and use them for any such purposes. In addition, it can also be used to record, edit and publish a video and/or reproduce written or oral quote(s) and copyrighted or trademarked material.
Comments: Form is protected from modification and enabled for form fill (includes tabbed fields for form completion).
Content Contact: Central Forms Unit
Document Attachment:
ADM-8767-E (English Electronic Version - pdf/657 KB)
ADM-8767-E-S (Spanish Electronic Version - pdf/96 KB)
Note: If you need this form in an alternate format, please send a message to the Content Contact listed above.
DWD Contact Information
201 E. Washington Ave
P.O. Box 7946
Madison, WI 53707
(608) 266-3131
Sign up for DWD news and updates
A proud partner of the 
network