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Permissions Request Form

Your Contact Details

Contact Name

Postal Address

Post/Zip code

Country

Email Address

Telephone

Fax

Details of your permission request

Our material

Title of book/journal

Title of chapter/paper

Page numbers

Author/editor's name

If your request is for a book

Name of book

Author/editor

Publisher

Estimated price

Estimated print run

If your request is for a course pack

Name of institution

Name of course

Name of tutor

Estimated number of students
If it's on the internet, what is the url?

Is it a secure site?

For how long will the material be accessible?

Additional information