RE:  Request for Permission to Reprint Published Material

Dear :

I am writing to request permission to reprint the Material (as defined below) from the following publication:

• Author: 
• Title: 
• Publication Name: 
• Date of Original Publication: 

I intend to use the following selection from the original published work: the "Material". The Material represents approximately percent of the original published work. I have enclosed copies of the Material with this letter for your convenience.

The Material will be used as follows, without deletions from, additions to, or changes in the text: .

The Material will not be used in a seminar or other educational activity. will be used in a seminar or other educational activity as follows: .

I hereby request nonexclusive worldwide English language rights, for this  only. If you are not the copyright holder, or if permissions from other sources are needed to obtain worldwide rights, please let me know and indicate the person or company to which such requests should be directed.

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.