Sample Forms for Requesting Permission
Permission to Quote from Interview or Internet Posting
Permission is granted to O'Reilly & Associates, Inc. for non-exclusive world rights in all languages, for use of the material indicated below, in the book by __________________________________ (author/s) titled ___________________________________________ (title of book), and for any subsidiary use, promotional use, future revisions, and future editions of the same: Material: (Full quotes to be used, and their source. If additional pages are necessary, indicate the number of pages attached. All pages should be signed by the copyright owner.) Credit for contribution to read: (Examples: Christina M. Johnson; Chris Johnson; Christina Marie Johnson) Permission is granted on ________________________________ (date) _________________________________________________________ (signature of owner of copyright) ________________________________________________________ (printed name) ________________________________________________________ (address) ________________________________________________________ (address)
Permission is granted to O'Reilly & Associates, Inc. for non-exclusive world rights to the following photograph(s) for use in _______________________________________________ (title of book), and for subsidiary use, promotional use, future revisions, and future editions of the same: From: ________________________________________________ (title of book, magazine and article, or other) By: _________________________________________________ (name of photographer) Material: From page(s)____________, described as ______________________________________________________, and consisting of a total of ______ photographs. The following credit line and copyright notice must accompany the use of this material: (Example: "Used by permission of Jane Doe, (c) Copyright Jane Doe 1995") Permission is granted on ___________________________________ (date) ____________________________________________________________ (signature of owner of copyright) ____________________________________________________________ (printed name) ____________________________________________________________ (address) ____________________________________________________________ (address)
For consideration, permission is granted to O'Reilly & Associates, Inc. for exclusive world rights, including copyright, and use of any photographs containing my image for use in ________________________________________________ (title of book) and for subsidiary use, promotional use, future revisions, and future editions of the same. I waive any right to inspect or approve final use of such photographs and I waive any right to file any legal actions, including libel or invasion of privacy, based on any use of the photographs under this release. I am over 21 and understand the content of this document. Permission is granted on _______________________________________ (date) ________________________________________________________________ (signature of model) ________________________________________________________________ (printed name) ________________________________________________________________ (address) ________________________________________________________________ (address)
Permission to Quote from Periodical
Permission is granted to O'Reilly & Associates, Inc. for non-exclusive world rights in all languages for use of the following material in _________________________________________________________________ (title of book) and any subsidiary use, promotional use, future revisions, and future editions of the same: From: ____________________________________________________________ (Magazine/Journal/Newspaper and title of article) By: ______________________________________________________________ (Author) Material: From page ________, line ________, through page ________, line _______, beginning with the words "___________________________" and ending with the words "________________________________________," and consisting of a total of _______ words. The following credit line and copyright notice must accompany the use of this material: (Example: "Used by permission of The Gazette, (c) Copyright The Gazette, June 10, 1995) Permission is granted on __________________________________________ (date) ___________________________________________________________________ (signature of owner of copyright) ___________________________________________________________________ (address) ___________________________________________________________________ (address)
Sample Request to Publisher
May 5, 1997
Dan Smith, Permissions
New University Press
New York, NY
This is to follow up our telephone conversation of May 2. I am writing to ask permission to reprint several quotes from your publication, Diamonds and Stones by Kathy St. John, copyright 1991. I am sending copies of the pages of our manuscript with these quotes boxed and page numbers from your book noted. I am also sending a copy of the source notes page for the chapter in which Diamonds and Stones is first quoted. All quotes will be referenced on the source notes page for the chapter in which they appear.
About our book:
Title: Holding Tight, Letting Go: Living with Metastatic Breast Cancer
Author: Musa Mayer
Est. Pub. Date: September 1, 1997
Est. Page Count: 350
Est. Price: $19.95
Audience: Holding Tight, Letting Go will be one of the first books in our new series of patient-centered health guides, written for consumers who wish to take a more active role in the care of their health.
Holding Tight, Letting Go is complementary to Diamonds and Stones, but is not directly competitive with it in that Holding Tight, Letting Go has the very specific focus of metastatic breast cancer. Although our book uses numerous quotes from many sources to illustrate its technical and psychological points, the heart-and main strength-of Holding Tight, Letting Go is the recounting of stories from metastatic breast cancer patients, culled from extensive interviews. We hope it will be successful, but are publishing it mainly because there is a real need for this kind of information and sharing of experience.
As to how the publication of our book might affect Diamonds and Stones, I think the most likely impact will be that the use of quotes from Ms. St. John will arouse our readers' interest in going on to read her book in full. We also plan to list Diamonds and Stones as recommended reading on our online Web site.
O'Reilly & Associates, Inc. is requesting nonexclusive world rights, as part of our volume only, in all languages and for all editions.
May we have your permission to reprint the referenced material in our book? Do you require acknowledgement other than that which we will include in our source notes?
Thank you for your consideration of this request.
The above request is hereby approved with any conditions specified on an attached page, and on the understanding that full credit will be given to the source.
Date: ____________________________________________________ Approved by: _____________________________________________
Sample Response from Publisher
July 7, 1997
Dear Ms. Sholes:
I apologize for the delay in our response. Your request unfortunately was temporarily lost in the transition after Dan Smith left this position.
Permission is hereby granted to reprint from pages 2, 12, 76, 81-82, 101, 178, 220, and 258-259 from Diamonds and Stones by Kathleen St. John, conditional on the following:
Term: One-time, non-exclusive use
Territory: English-language world
Fee: $100.00 plus one copy of the book
Credit Line: St. John, Kathleen, Diamonds and Stones, copyright (c) 1991 by Kathleen L. St. John. Reprinted by permission of New University Press.
Please sign and return the enclosed copy of this letter to me, giving your projected publication date. If material is not used, please notify me so I can clear my records.
Jane Mitchell Permissions Manager
____________________________________ __________________________________ Signature Projected Date of Publication
Sample Request to Web Site
January 27, 1997
Dear Ms. O'Neill,
I am writing to request permission to use a chart on one of the To Your Health web pages in our forthcoming book, Partners in Health. Please review the following request and return to me with your electronic signature.
Carol Sholes, firstname.lastname@example.org
O'Reilly & Associates, Inc.
1005 Gravenstein Highway North
Sebastopol, CA 95472
Permission is granted to O'Reilly & Associates, Inc. for non-exclusive world rights in all languages for use of the following material in Partners in Health and any subsidiary use, promotional use, future revisions, and future editions of the same:
From: How to Record Your Medical History
Credit line/copyright notice to accompany this material:
Permission is granted on (date):
Sample Response from Web Site
Date: Wed, 29 Jan 1997 15:28:32 +0000 (GMT)
From: ONEILL 223-3002
Subject: Re: To Your Health Chart Request
To: Carol Sholes (email@example.com)
I am in receipt of your request to reproduce a To Your Health chart in your book, "Partners in Health". This request will be granted subject to the following:
1) Use of the following credit line: Reproduced with the permission of To Your Health, a service organization promoting patient empowerment and preventative health care.
2) If the URL address is being used in your book, the correct address is http://www.toyourhealth.com/med_history.html.
3) Provide us via facsimile (508/493-6985) with a snapshot of the To Your Health page(s)to be used with the related text.
4) No other right, license or interest is granted by either party to the other.
We would appreciate receiving a complementary copy of the above named publication(s). The mailing address is To Your Health, Attn: Lynn O'Neill, 123 Uphill Road, Goodtown, CA. 95000
TO YOUR HEALTH
Assistant to the Director