Please send me the gemstone image slide listed below. By completing and emailing this form to ICA, I agree to comply with the terms and conditions for usage, which are as follows:

	-	Wherever these images are used, photo credit must be given to ICA as well as to any other person(s) or companies named on the slide.
	-	A copy of the article or publication in which the image appears should be sent to ICA at 19 West 21st Street, Suite 705, New York, N.Y. 10010-6805, U.S.A..
	-	The slide images may not be copied for future use.
	-	All slides listed on this form must be returned to the ICA within 30 days of the date of shipping.
	-	A charge of $100 each will be made for all slides lost or not returned to ICA.

Please list below which slides you require. If you are not an ICA member, please also indicate whether the images will be published in a book or used for commercial purposes. *One-time usage charge for ICA members is $25, authors $50, commercial usage $100. There is no charge to bona-fide trade press publications.

Slide Code #	Name of slide	Indicate Usage Category*	Cost per slide	Amount Due
			TOTAL

Shipment Fee: $35 ( if Fed, Ex, number not available* )			=   $
Total Charges			=   $
Please mail the slides to: Name: Company or Publication: Street: City: Zip Code: Country: Tel: Fax: E-mail: Federal Express Account No. (if not available, please add $35 shipping cost above*)
Please send your Credit Card data by Fax or Email to: INTERNATIONAL COLORED GEMSTONE ASSOCIATION 19 West 21st Street, Suite 705 New York, N.Y. 10010-6805 U.S.A. Tel: 212-620-0900 Fax: 212-352-9054 email: ica (at) gemstone.org