African Snakebite Institute – Image use request form

Please complete the Image Use Request form below, in order for us to review your request.

Please note, approval is not automatic – one of our team will revert within 7 working days of form submission.

Name*
First Last
Company
Cell phone number*
Email*
Date of Request:*
DD slash MM slash YYYY
Link to the image you'd like to use:
Link to the image you'd like to use:
Link to the image you'd like to use:
Link to the image you'd like to use:
Link to the image you'd like to use:
What will the image/s be used for?*
Example of work where image/s will be used?*
I hereby request to use the above mentioned image on the above mentioned platform only. I confirm that the image will not be changed or altered in any way, and credit will be given to African Snakebite Institute / Johan Marais.*
- Agree
- Disagree