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Author Information > Print and Electronic

Terms:
Non-exclusive, Print and Electronic, one-time use in English only, provided that a credit line for the source appears with the reprinted material.

All fields are REQUIRED INFORMATION
Permission Request Form.

General Information
Title:
Full Name:
Company: (10 digits)
Phone:
Fax: (10 digits)
Email Address:


Permission Information
Decker title:
Name(s) or Author(s):
ISBN (for ACP Medicine & ACS Surgery):
Publication Date (mm/dd/yyyy):  Click Here to Pick up the date
Journal Volume and Issue #'s:
Chapter Number/ Page Numbers/ Figure Numbers:


Manuscript Information
Tentative Title:
Figure/Table(s) Name will be:
Purpose of Reproductions:
For Distribution: Yes
No
For Release: Yes
No
Publisher Estimated Print Run:
Publication Date (mm/dd/yyyy):  Click Here to Pick up the date
Medium (Internet/ CD-ROM):
Password Protected Site: Yes
No
Site URL:
Number or Estimated Users:
Duration to be posted on website:




If after you have filled out the REQUIRED information, and the fields do not cover the extent of your request, please add the REMAINING details in the email box below.
Email Box:
  
Thank you for your request. Due to high volume and time to review, our Permissions Department requires at least 7 business days to reply. If urgency requires a faster follow-up, please call 1.905.522.8526 x2291

Rights & Permissions
Decker Publishing Publisher