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Permission Request Form | Print |

All material published by Thieme Medical Publishers, Inc. is protected by the U.S. Copyright Act. Permission to use Thieme material must be secured in writing. Permission is granted for one-time use in the manner described herein under the condition that the material is original to our product and that a standard credit line appears on the same page as our material.

Please fill in the form below and print it out. The form must be faxed to (212) 947-1112, together with a copy of the material you are requesting permission to use.
NOTE: Permission requests cannot be processed without a copy of the original material.

Requestor Information

First Name*
Last Name*
Address*
Address (cont)*
City and Zip Code*
State*
Country*
Phone*
Fax*
E-Mail*
*(required fields)



Request Information

Source Book Journal
Electronic Media
Author(s)
of Thieme Book or Journal
Title
of Thieme Book or Journal
Figure/Table Number
in Thieme Book
Book Edition
Journal Volume/Issue Number
Copyright Year
Page Number(s)
Author of your Work
Title of your Work
Copyright Year of your Work
Format of your publication Print
Electronic Media
Number of Copies for Distribution
(if applicable)
Additional Comments:

 
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