Fields marked with an * are required

I HEREBY AUTHORISE THE IRISH VISUAL ARTIST’S RIGHTS ORGANISATION LIMITED (“IVARO”) as my sole agent, to carry out the following functions on my behalf in relation to artistic works of which I am the author:

1. Subject to my agreement on a case by case basis, to authorise the exploitation of the copyright in my works by reproduction or otherwise, and to negotiate and settle an appropriate royalty in respect thereof.

2. Regarding Droit de Suite (Artists’ Resale Right), to apply for information concerning sales of my works and payment of such resale royalties as may be due to me in consequence of the resale of my works or any of them.

3. In relation to works by me already reproduced in published books and journals, to permit the inclusion of the reproductions of the same in standard licences for reproduction issued to educational institutions, businesses and others, by the relevant agency or agencies in Ireland and elsewhere, upon terms considered reasonable by the board of IVARO.

4. To apply to foreign and international agencies responsible for the collection of royalties and fees due to artists in respect of the exploitation of their works, for any such royalties and fees as may be due to me.

5. To receive all such royalties and payments on my behalf, and to give receipts therefor, provided that, after deduction of the appropriate administrative charge calculated in accordance with the rules of IVARO, the balance due to me shall be remitted to me in a timely fashion.

6. In a general way, but without any specific obligation, to represent my interests in relation to the protection of the copyright in my works, and the enhancement of my rights, and the rights of visual artists generally.

I agree to indemnify IVARO for any loss or damages it may suffer as a result of payments made to me pursuant to this agreement for which I am not legally entitled.