Institute for the History & Philosophy of Science & Technology
Imago Image Donation Form
Please fill in as many of the following fields as possible.
Those fields marked with an asterisk (
*
)
must
be filled in.
*
URL of your image:
*
What is the image of?
Does it have a title?
Information on the Subject of the Image
Location:
Author/Creator:
Date:
Information on the Image Itself
Photographer/Creator:
Date taken/made:
*
Owner of the negative:
This image is scanned from a
<choose a medium>
-Slide
-Photograph
-Book/monograph
-Serial/journal
-Digital Image
Description:
*
Keywords:
References:
(articles, books, web sites, etc.)
*
Your Name:
*
E-Mail:
*
Affiliation:
