TSDA Publication Permission
Form
I agree to submit my presentation for
publication on the Thoracic Surgery Director's Association (TSDA)Web site. For
the materials that I own (including text, image and audio), I hereby assign the
copyright to the TSDA.
For all materials that I do not
own (listed below), I have attached a "TSDA Permission to Reprint
Form."
Title of Presentation
Print Name
Signature
Date
Institution
Address
Phone Fax
TSDA Permission to Reprint
Form
I am writing to request permission
to reprint the following material from your publication:
Description:
This material will appear as
an image on the TSDA Web Site (http://www.tsda.org/) and on the affiliated CTSNet
Web site (http://www.ctsnet.org/). This publication will be available to the
public without charge and is intended for educational purposes.
I am requesting
the nonexclusive world rights to use this material as part of my work in all
languages and for all editions.
If you are the copyright
holder, may I have your permission to reprint the material described above?
Unless you request otherwise, I shall use the conventional scholarly form of
acknowledgement, including author and title, publisher's name and date.
If you are not the copyright
holder, or if for world rights I need additional permission from another source,
please provide me with that information.
Thank you for your consideration
of this request.
Name:
Institution:
Phone:
E-mail:
The above request is approved
on the conditions specified above and on the understanding that full credit
will be given to the source.
Approved by:
Date:
Additional Comments:
