Copyright and Reprint Permission Request Form

Name of requester

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Exact title of the publication you are seeking permission to reprint

If you have several publications, and the request is the same for each, please separate the titles with semicolons. If each intended use is different, please fill out a separate form for each resource.

Date of the publication you are interested in reproducing

There are sometimes different versions of our materials, particularly in print circulation. The date will help us know which version you are interested in.

How much of the publication are you interested in reproducing?

If you answered "part," please list page numbers or describe which part

Format of requested reproduction

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If print, the number of copies to be reproduced

Have you previously received permission from us to reproduce material in a similar way?

What is the approximate period of time you will be distributing the material?

Nature of intended use

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Please provide any additional details such as purpose or other contact information

Copyright and Reprint Permission Request Form

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