Copyright Permission Request

Please provide complete information. Your request will be reviewed, and a response will be sent to you as soon as possible.

I request permission to copy the listed material for the following use (see below):

Requested By:

Company:

City:

State:

Email Address:

Telephone:

Fax:

ARE YOU AN AMTA MEMBER?

YES

Member No.

NO

MATERIAL TO BE USED:

- Photo/Illustration
- Article
- Other (specify) 

Publication (Title, Vol., No., Pg.):

Article Title:

Pages:

No. of Copies & Copying Method:

PROPOSED USE OF COPYRIGHT MATERIAL (please give detailed description):