Please print and complete this form and mail it to:

LHEF, Inc.
484 14th Street
Brooklyn, New York 11215




Name of Donor: __________________________________________________________________________ Address: ________________________________________________________________________________

Phone: ____________________________________ E-Mail_______________________________________


I agree to donate the material described below to the Lesbian Herstory Archives (LHA) of the Lesbian Herstory Educational Foundation, Inc. (LHEF) to become its personal property.   All property rights of the material or objects donated are granted to the LHEF, Inc.  This material may be made available for browsing and research, subject to restrictions which may appear below.


Description of material.  Identify the creator(s) of each item; indicate if unknown:




Any items in this collection not retained by LHEF (duplicate books or periodicals, for example) are to be (initial one):


            Returned to donor ________.

            Disposed of at LHEFŐs discretion________.


Any copyright the donor possesses to publish or reproduce this material in print, video, film, or other recorded format is (initial   one):


           Reserved by the donor requiring written consent prior to each publication until death whereupon it is

            assigned to LHEF, Inc.________.


           Assigned at this time to LHEF, Inc.________.

           Other (as stipulated below or on reverse)________.


LHEF (check one) may _____ may not _____ list my name and a general description of the contents of my Special Collection on the

           LHA website.


I understand that all responsibility to obtain publication or reproduction permission rests solely with individual researchers, not with    

           LHEF, Inc.  Researchers may take photographs or make photocopies of this material for personal use instead of note taking.


LHEF (check one) may___ may not___ provide researchers with my address and phone number for publication permissions.


Access to this material is restricted as follows:



Display of this material by LHEF is restricted as follows:



Donor Signature: __________________________________________________________Date: ____________


Received by: _____________________________________________________________Date: ____________



LHEF, Inc. seeks material from all lesbians.  Access to collections is granted without regard to academic, sexual, or political credentials.