PERMISSION REQUEST FORM JOURNALS & BOOKS


      Please respond to me via:


    E-mail:

    Fax:
      Type of Publication:


    Book:

    Journal:



DESCRIPTION OF MATERIAL YOU ARE REQUESTING TO REPRODUCE

      Title of Publication:

      Author/Editor:

      Year/Volume/Issue/Edition N°:

      Title of Article/Chapter:

      Figure or Table N¦:

      ISBN:

DESCRIBE PUBLICATION USE
(in a text, journal, on-line, internal, in which language, for which publisher, print run, list price, etc)

CONTACT INFORMATION

      First name:

      Last name:

      Title:

      Publisher / Agency:

      Address:

      City:

      Postal/Zip code:

      Country:

      Phone:

      Fax:

      E-mail: