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Permission Request Form

Date:

Please complete this form as fully as possible. Our aim is to provide an initial reply to your request within no more than two working weeks.

Name:
Address:


Town:
Post Code:
Country:
Email:
Fax:
Telephone:

Title of Book		Journal	:

Title:

Year of publication:

Book Author	Editor	:

Name:

Book ISBN:
or
Journal volume and issue no.:

Rights requested

Material to be reproduced (give full details including author and article title where appropriate; page number(s) for extract/figure number(s)/etc.):

Translation		Reprint

Translation language:

The publication in which the extract will be reproduced

Author		Editor

Name:

Working title:
Publisher (if not requester):

Market territory:	World	Other

Format:	Print	CD-ROM

Extract as a percentage of your publication as a whole (%):

Estimated total print run/quantity:

Estimated date of publication:

Estimated selling price:
Send request to: Cambridge \| New York \| Melbourne