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Request Permission to Republish Copyrighted Material

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Form 3: Request Permission to Republish Copyrighted Material  



Note: The bold fields are required.  

Your Name:
Your Email:
Your Telephone:
You are:
Title:
Author:
Title and Author for Article/Chapter
(if applicable):
Publisher:
Date of Publication:
Pages:
Republishing Format:
(select one)
Book
Journal Article
Brochure or Pamphlet
Newspaper
Report or Working Paper
Presentation (e.g., PowerPoint)
Other:
If the material will be published in print:
     Estimate the distribution or circulation for the publication:
If the material will be published in electronic format:
     Estimate the number of users who can access the publication:
Estimate the month and year to be published:
Additional Information or Comments:


Copyright law of the United States (Title 17 USC) governs the making of photocopies or other reproductions of copyrighted material.