1
230 Third Avenue, Waltham, MA 024517528 USA www.uptodate.com Tel: 17813922000 Permission to Reproduce UpToDate ® Material All UpToDate material is protected by copyright. Permission to reproduce UpToDate material in another publication must be secured in writing. Please complete the information and return this form. Email: [email protected] Mail: Permissions UpToDate Fax: +1 (781) 3704793 230 Third Avenue Waltham, MA 024517528 United States Requestor Information Name Title Institution Address City State Zip Country Phone Fax Email Topic/Graphic Information UpToDate topic title UpToDate figure title (Figure titles can be found in the outline of each topic. If you are requesting permission to reproduce a figure, you must also indicate the UpToDate topic title above.) Format In which format will the UpToDate material be reproduced (please check all that apply): Print CD/DVD Internet Other (please describe) Publication In which publication will the UpToDate topic/figure be reproduced? Title Publisher Author/Editor Publication date of material If possible, please include a copy of the material you are requesting permission to reproduce.

Permission to Reproduce UpToDate® Material Word - Permission to Reproduce UpToDate® Material Created Date 20150624143904Z

Embed Size (px)

Citation preview

Page 1: Permission to Reproduce UpToDate® Material Word - Permission to Reproduce UpToDate® Material Created Date 20150624143904Z

 230  Third  Avenue,  Waltham,  MA  02451-­‐7528  USA    

www.uptodate.com  Tel:  1-­‐781-­‐392-­‐2000  

Permission  to  Reproduce  UpToDate®  Material    

All  UpToDate  material  is  protected  by  copyright.  Permission  to  reproduce  UpToDate  material  in  another  publication  must  be  secured  in  writing.  Please  complete  the  information  and  return  this  form.    Email:    [email protected]   Mail:    Permissions  

UpToDate  Fax:    +1  (781)  370-­‐4793   230  Third  Avenue  

Waltham,  MA  02451-­‐7528  United  States  

Requestor  Information  

Name      

Title      

Institution      

Address      

   

City      State      Zip        Country      

Phone      Fax      

Email      

 

Topic/Graphic  Information  

UpToDate  topic  title    

   

UpToDate  figure  title      

(Figure  titles  can  be  found  in  the  outline  of  each  topic.  If  you  are  requesting  permission  to  reproduce  a  figure,  you  must  also  indicate  the  UpToDate  topic  title  above.)    Format    

In  which  format  will  the  UpToDate  material  be  reproduced  (please  check  all  that  apply):  

           Print                  CD/DVD                Internet                Other  (please  describe)      

 Publication    

In  which  publication  will  the  UpToDate  topic/figure  be  reproduced?  

Title      

Publisher      

Author/Editor      

Publication  date  of  material      

 

If  possible,  please  include  a  copy  of  the  material  you  are  requesting  permission  to  reproduce.