Permission to Reprint Material

 

I am writing to request permission to reprint the following material from your publication:

Description:

This material is to appear as an image on

_____________________________________________________________

in the section entitled

_____________________________________________________________ which the

_________________________________________________________________

is currently preparing for publication. This publication will be available to the public without charge.

I am requesting the nonexclusive world rights to use this material as part of my work in all languages and for all editions.

If you are the copyright holder, may I have your permission to reprint the material described above. Unless you request otherwise, I shall use the conventional scholarly form of acknowledgement, including author and title, publisher's name and date.

If you are not the copyright holder, or if for world rights I need additional permission from another source, will you kindly so indicate.

Thank you for your consideration of this request. A duplicate copy of this request is enclosed for your convenience.

 

Yours sincerely,

 

 

The above request is approved on the conditions specified below and on the understanding that full credit will be given to the source.

 

Approved by:

 

Date: