REQUEST FOR PERMISSION

TO REPRINT PUBLISHED MATERIAL

TO: Copyright Permissions Department Date:

(name and)
(address of) Publisher’s FAX:
(publisher)

I am writing to request permission to reprint the following material from your publication:

Author/Title/Name of Journal/Date of Original Publication:

Pages (and figure/table numbers) as they appear in your publication:

I am attaching photocopies of the material to be reprinted from your publication: “ yes “ no

This material is to appear as originally published (any changes or deletions are noted on the reverse side of this letter) in
the following collective work that the American Institute of Physics, a nonprofit organization, is now preparing for
publication:

Title of the conference proceedings volume:

Editor of the conference proceedings volume:
Proposed date of publication:
The title of my paper:

We request nonexclusive world rights, for this volume only, in all languages and editions, including nonprinted editions.
If you are the copyright holder, may I please have your permission to reprint the above material in our Proceedings
Volume? If you do not indicate otherwise, we will use the usual scholarly form of acknowledgment, including publisher,
author, title, etc. If you are not the copyright holder, or if additional permission is needed for world rights from another
source, please so indicate.

Please return the original signed copy to me at the following address and retain a duplicate for your records:
(name and )
(address of )
(AIP Author)

Sincerely yours, _______________________________________ AIP Author’s FAX:

Signature of AIP Author

AIP Author: Please fill out above this line and send to the other publisher.
Note, this is not an AIP Transfer of Copyright Agreement.

The above request is hereby approved on the conditions specified below, and on the understanding that full credit will be
given to the source.

Approved by:_________________________________________________ Date:______________

(for Publisher)
Required credit line: