(SAMPLE) REQUEST FOR PERMISSION TO REPRINT
November 1, 2001
To: Permissions Department
Lippincott Williams & Wilkins
530 Walnut Street
Philadelphia, PA 19106-3621
From: Jane Doe
145 Harrison Ave.
Boston, MA 02111
Dear permissions editor,
I am writing to request permission to reprint material from the book Langman's Medical Embryology, by Thomas W. Sadler, Philadelphia: Lippincott Williams & Wilkins, ©2000. I wish to use 11 figures total. Photocopies of the figures, 20.10, 15.1, 15.2, 15.5, 15.6, 15.8, 15.12, 15.15, 15.22, 15.23, 15.28, are enclosed for your reference.
These figures will appear in unaltered form as part of an electronic syllabus for the course Medical Gross Anatomy offered January 15 - May 21, 2002. The materials will be posted on a secure, password protected server that is accessible exclusively to students and faculty within the medical, dental, and veterinary schools at Tufts. Materials will be posted for the duration of the Spring 2002 semester. All copyrighted materials will be deleted from the server upon termination of the course.
If for some reason you do not own the copyright for these materials, I would appreciate any information you can provide concerning the proper person or company with whom I should inquire.
Please respond in writing to indicate whether permission is granted and inform me of any fees or conditions that may be required. In addition to the terms of agreement, please also indicate how you wish to be credited.
Thank you for your time and consideration of this request. I look forward to hearing back from you at your earliest convenience.