This is a fillable permission to reprint published material. Click any blank field in the document below, type your information, and your entries will autosave in your browser. Use the toolbar at the top to print, save as PDF, or download a completed copy. Below the form, you'll find a guide to using this document, common mistakes to avoid, and answers to the questions we hear most often about permission to reprint published material.
Name (the "Owner") has received the request of Name (the "Requestor"), in a letter dated Date to reproduce the Material (as defined below). The Owner grants the request on the following terms, and the Requestor agrees as follows:
1. The published work described below (the "Work") is the subject of this agreement:
The Owner is the sole copyright holder of the Work.
2. The Owner hereby grants permission to the Requestor to use the following selection from the Work: Description (the "Material"). The Material represents approximately Percent % of the Work. A copy of the Material is attached to this agreement as Exhibit A.
3. The Requestor may use the Material only as follows, without deletions from, additions to, or changes in the text: Uses .
4. The Requestor may Yes / No not use the Material in a seminar or other educational activity without restriction only as follows: Restrictions .
5. As consideration for the grant of the Owner's permission to use the Material, the Requestor shall pay to the Owner a one-time fee of $ Amount (the "Fee"). The permissions granted under this agreement are ineffective until the Fee is paid in full.
6. This agreement provides nonexclusiveYes / No worldwide English language rights, for this Volume / Issue / Edition volume only.
7. Every copy of the Material used must include, either on the copyright page or as a footnote on the page on which the Material begins or, if in a periodical, on the first page of the quotation, the following credit line: Credit line . If the copyright and acknowledgment notices are not printed as specified, all permissions granted by this agreement are canceled without further notice.
8. The Owner makes no representations about the Requestor's use of the Material. More specifically, the Owner has not obtained any releases covering the Requestor's use of the Material and the Owner does not represent that the Requestor's use of the Material will not infringe the rights of any third parties. The Requestor shall indemnify the Owner against any claims, damages, liabilities, losses, or expenses (including reasonable attorneys' fees) that may arise out of the Requestor's use, reproduction, or distribution of the Material.
9. This agreement will terminate automatically if the volume is not published within Years years from the date written below. In addition, the Owner may terminate the agreement at any time on Days days' notice, or immediately if the Requestor does not comply with any term of this agreement.
10. On termination of the agreement, all rights granted under this agreement, including the Requestor's right to use the Material, will end. The Requestor shall promptly discontinue its use of the Material and may no longer reprint, publish, or distribute the volume . However, the Requestor will have an additional Years years from the time the permission terminates within which to sell existing copies of the volume . However, if the termination of permission is caused by the Requestor's violation of any provisions of this agreement, the Requestor may not sell any additional copies of the volume .
11. The laws of the state of State govern this agreement (without giving effect to its conflicts of law principles).
12. The Requestor shall furnish to the Owner one complimentary copy or tear sheet for each publication, except motion pictures, in which the republished Material appear, on or before publication of the republished Material. If permission has been granted for electronic reproduction, the Requestor shall furnish the Owner with the internet or other electronic address at which the republished Material will appear.
13. Nothing in this permission conveys any intellectual property rights or other interests to the Material or Work, and the Requestor may not reproduce, distribute, sell, or transfer all or part of the Material or Work. The Owner retains its own right to publish the Material or Work, or to grant permission for others to publish the Material or Work. The permission granted in this release is neither severable nor transferable to a third party. Any attempted transfer is void and of no effect.
SIGNATURE PAGE FOLLOWS
Each party is signing this agreement on the date stated opposite that party's signature.
| OWNER | Owner Name | ||||||
| By:____________________________________________________ | |||||||
| Name: Name | |||||||
| Title: Title | |||||||
| REQUESTOR | Requestor Name | ||||||
| By:____________________________________________________ | |||||||
| Name: Name | |||||||
| Title: Title |
PAGE BREAK HERE
EXHIBIT A
Attach copy of Material