It's 3 easy steps!

Step 1: FILL OUT THIS FORM

Step 2: COMPLETE PAYMENT

Step 3: SEND US YOUR JPG IMAGE TO MOSAIC@MOST.ORG AND WAIT FOR CONFIRMATION. Image should not be larger than 2-3 MB's.

CONSENT - I give to the Milton J. Rubenstein Museum of Science & Technology (the "MOST") all rights necessary for the MOST to display, use, change, and copy my image (and/or the photograph I am submitting) as part of the MOST's "Photo Mosaic" project, and for any other purpose supporting the MOST (including advertising and promoting the Photo Mosaic), forever. If I am submitting a photograph or other image, I promise to the MOST that my photograph is an original work, I have the right to submit it and to grant the above rights to the MOST, and that my doing so will not violate anyone's copyright, trademark, or other rights. I understand that the MOST may for any reason choose not to use my image or photograph in the Photo Mosaic.

Mosaic Campaign Patron
	Quantity in Basket: None Code: MOSP Price: $250.00
	Image: I will send my image by email from the email I will provide in my order, as an attachment (JPG only). I will send my image by mail as a hard copy photo. I will bring it into the museum. I will come into the museum to have it taken.   I agree to the terms of consent.
	Quantity: