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					 Image(s) use :					 |  | 
					  
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					Reproduction format of the image in the final document :					 |  | 
					  
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					Print run of the document on which the image is reproduced :					 |  | 
					  
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					Number of consecutive uses : |  | 
					  
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					If image is reproduced in the Press, please specify number of titles :					 |  | 
					  
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					If image is reproduced as a poster please specify size of the poster :
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					Give all useful information or specify the use of the image(s) in this box :					 |  | 
					  
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