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Copyright Permission Request Permissions DepartmentTurner White Communications, Inc. 125 Strafford Ave., Suite 220 Wayne, PA 19087 FAX: (610) 975-4564 Date:____________________ Attention: Permissions Department Our company, ________________________________________, requests your permission to reprint Journal (Circle): Hospital Physician, Journal of Clinical Outcomes Management, Seminars in Medical Practice Title of article: _____________________________________________ Author(s): ________________________________________________ Year of Publication:________ Volume/Issue:_________ Page(s):________ Number of copies to be made:_______ |
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Requested material is:
(please select one) ____Table ($200) ____Figure ($200) ____Article |
Requested material will be used in:
(please select one) ____Book ____Journal ____Other ___________________________________________________
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If permission is granted, the requested material would be used as: Academic use (Course):___________________________________________ Title of proposed work:___________________________________________ Publisher: ______________________________________________________ Mailing address: _________________________________________________ Contact person and title: __________________________________________ Phone: __________________________
Sincerely,
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