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GOT PHOTOS ?


Photo Rewards Program Submission Form

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Researcher First Name


Researcher Last Name


Institution


Oracle # (Any PO, Order # or Acct #)


Catalogue Number (primary and secondary antibody)


Date Picture Taken (dd/mm/yyyy)


Sample Details (Type, tissue, cells, fixation, etc.)


Application (IHC, IF, WB, FC, etc)


Picture Caption


Upon submission of this form, I hereby provide EMD Millipore Corporation (“EMD Millipore”) the ability to use my photos and/or research articles in its upcoming product newsletters, web site, product catalogs and marketing collateral, I hereby authorize EMD Millipore and/or its agents to reproduce, publish and otherwise make available my Publication materials, which may include, but is not limited to, biological photos and research articles (“Materials”) to EMD Millipore’s customers, invitees or other related parties pursuant to the publication policies established by EMD Millipore. I understand that my Materials may be reproduced and distributed by EMD Millipore, in its sole determination. In addition, I also allow my Materials to be posted on EMD Millipore’s Web site for such periods to be determined in EMD Millipore’s sole discretion. I represent that: 1) I am the sole owner of all rights to the Materials; and 2) to the best of my knowledge, the content of the Materials is accurate and my Materials do not infringe on the rights of others and do not contain any matter which is slanderous, defamatory, disparaging of any products or services, or otherwise illegal. *

Contact Information



Company:
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Last Name:
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Telephone:
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Email Address:
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Department:
(university only)
Address 1:
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Address 2:
City or Town:
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State or province:
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Zip or postal code:
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Country:
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Security and Privacy:
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I agree to the Security and Privacy Policy.









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