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Permission Request Form
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Permission Request Form
Please use this form to submit your request.
Personal Details
*Title
*First Name(s)
*Surname
*Email
*Telephone
Fax
Occupation
*Preferred job title
Company name
*Address
Address line 2
*Town/City
*County
*Country
Select...
UNITED KINGDOM
--------------------
ABERBAIJAN
AFGHANISTAN
ALBANIA
ALGERIA
ANDORRA
ANGOLA
ANGUILLA - B.W.I
ANTIGUA
ANTILLES
ARGENTINA
ARMENIA
AUSTRALIA
AUSTRIA
BAHAMAS
BAHRAIN
BANGLADESH
BARBADOS
BELGIUM
BELIZE
BELORUSSIA
BENIN
BERMUDA
BHUTAN
BOLIVIA
BOSNIA AND HERZEGOVINA
BOTSWANA
BRAZIL
BRUNEI
BULGARIA
BURKINA FASO
BURMA
BURUNDI
CAMBODIA
CAMEROON
CANADA
CAYMAN ISLANDS
CHAD
CHANNEL ISLES
CHILE
CHINA
COLOMBIA
CONGO
COOK ISLANDS
COSTA RICA
CROATIA
CUBA
CYPRUS
CZECH REPUBLIC
DEM REP OF CONGO
DENMARK
DJIBOUTI
DOMINICA
DOMINICAN REPUB
EAST TIMOR
ECUADOR
EGYPT
EL SALVADOR
EQUATORIAL GUIN
ERITREA
ESTONIA
ETHIOPIA
FALKLAND ISLES
FAROE ISLANDS
FIJI
FINLAND
FRANCE
FRENCH GUIANA
FRENCH POLYNESIA
GABON
GAMBIA
GEORGIA
GERMANY
GHANA
GIBRALTAR
GREECE
GREENLAND
GRENADA
GUAM
GUATEMALA
GUINEA
GUINEA-BISSAU
GUYANA
HAITI
HONDURAS
HONG KONG
HUNGARY
ICELAND
INDIA
INDONESIA
IRAN
IRAQ
ISRAEL
ITALY
IVORY COAST
JAMAICA
JAPAN
JORDAN
KAZAKHSTAN
KENYA
KIRIBATI
KUWAIT
KYRGYZSTAN
LAOS
LATVIA
LEBANON
LESOTHO
LIBERIA
LIBYA
LIECHTENSTEIN
LITHUANIA
LUXEMBOURG
MACEDONIA
MADAGASCAR
MALAWI
MALAYSIA
MALI
MALTA
MAURITANIA
MAURITIUS
MEXICO
MICRONESIA
MOLDAVIA
MONACO
MONGOLIA
MONSERRAT
MONTENEGRO
MOROCCO
MOZAMBIQUE
NAMIBIA
NEPAL
NETHERLANDS
NEW CALEDONIA SOUTH PACIFIC
NEW ZEALAND
NICARAGUA
NIGER REPUBLIC
NIGERIA
NIUE
NORTHERN IRELAND
NORWAY
OMAN
PAKISTAN
PANAMA
PAPUA NEW GUINE
PARAGUAY
PERU
PHILIPPINES
POLAND
PORTUGAL
PUERTO RICO
QATAR
REPUBLIC OF IRELAND
ROMANIA
RUSSIA
RWANDA
SAIPAN
SAO TOME
SAUDI ARABIA
SENEGAL
SERBIA
SEYCHELLES
SIERRA LEONE
SINGAPORE
SLOVAK REPUBLIC
SLOVENIA
SOLOMONS
SOMALI REP.
SOUTH AFRICA
SOUTH KOREA
SPAIN
SRI LANKA
ST HELENA
ST KITTS
ST LUCIA
ST VINCENT
SUDAN
SURINAM
SWAZILAND
SWEDEN
SWITZERLAND
SYRIA
TAIWAN
TAJIKSTAN
TANZANIA
THAILAND
THE MALDIVES
TOGO
TONGA
TRINIDAD
TUNISIA
TURKEY
TURKMENISTAN
TURKS & CAICOS ISLES,B.W.I
U.S.A.
UAE
UGANDA
UKRAINE
UNITED KINGDOM
URUGUAY
UZBEKISTAN
VANUATA
VENEZUELA
VIETNAM
VIRGIN ISLANDS (UK)
VIRGIN ISLANDS (US)
WESTERN SAMOA
YEMEN
ZAMBIA
ZIMBABWEX
*Postcode
Permission Requests
*Title of publication
*Edition
Author (if available)
Copyright date
* Brief description of your request
* Specific list of materials you wish to reproduce. (i.e. pages, tables, pictures, etc...)
(Note: We may contact you for copies of the specific materials)
* Number of subjects/administrations or copies needed per year
Name of party responsible for tracking reproductions and payment of fees
Inclusive Dates
Adaptation and/or format changes required? (i.e., computer-adaptation, scannable format, 3-part paper)
Is this request for permission to translate?
Yes
No
If yes, please also complete additional
Section II
.
Is this request for permission to use materials in a book?
Yes
No
If yes, please also complete additional
Section III
.
Permission Requests - Section II (Translation Information)
For request to translate, please complete the following additional information:
Name of Language
Purpose of Translation
Name and qualifications of the individual(s) who will be conducting the translations:
Name and qualifications of a separate individual who will back-translate the materials for our review:
Qualifications of all individuals who will use the translated materials:
Where will the test be used?
How do you intend to ensure test security?
How do you intend to track the number of reproductions for reporting to us for billing purposes?
Additional Comments
Permission Requests - Section III (Publishing Information)
If for a book, please provide the following additional information about your product:
Title of your publication
Type of media (i.e., CD-ROM, print, etc...)
Publisher
Approximate date of publication
Additional Comments
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