REQUEST TO REPRINT COPYRIGHTED MATERIAL
BY NONPROFIT ORGANIZATION
To: ______________________________________________
(Copyright Holder)
__________________________________________________ (Address)
Re:
____________________________________________ (Material to be Reprinted)
We, ____________________________ (Name of
Organization), are preparing materials for the purpose of teaching
_________________________ (Subject of Teaching). The previously mentioned materials will be used for/in
____________________________, and will be produced in _______ (Number)
volumes. In all, we would like to
distribute approximately __________ copies.
The final product will be distributed without profit. Following the above stated guidelines, we
request your permission to reprint the following material:
___________________________________________________.
In addition, we will include a credit line in the
reproduction which states the following: This material was reprinted from
____________________________ (Name of Original Publication), with permission
from _______________________ (Copyright Owner). Copyright Ó _____ (Year).
____________________________________ __________________
Signature of Copyright Owner Date
With the signing of this document, permission is
hereby granted to ______________________ (Name of Nonprofit Organization) to
reprint the previously mentioned copyrighted material.
___________________________________ __________________
Signature of Copyright Owner Date
