|Copyright Permissions Department
RE: Request for Permission to Reprint Published Material
I am writing to request permission to reprint the Material (as defined below) from the following publication:
I intend to use the following selection from the original published work:
The Material will be used as follows, without deletions from, additions to, or changes in the text:
I hereby request nonexclusive
I acknowledge that submission of this request does not constitute permission, and that any use of any copyrighted text owned by the copyright holder is unauthorized unless I have received a signed letter of permission or agreement. I further acknowledge that if any usage or administrative fees are assessed by the copyright holder, a signed letter of permission or agreement may be withheld until those fees are paid.