Copyright Permission Request

We will review your request and respond to you as soon as possible.

*required

About you

Your full name*

Company

Address

Street name and number

Suite, building, etc.

City

State

ZIP code

Email*

Ex: name@example.com

Phone*

Ex: 555-555-5555

Fax

Member

I am an AMTA member

Member ID

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Materials requested

Materials*

• Photo/illustration
• Article
• Other

Specify other

Publication

Title, Vol., No., Pg.

Article title

Pages

# of copies & copying method

Proposed use

Describe how you plan to use the copyrighted material.

“I request permission to copy the listed material for the following use…”

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