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SAMPLEPERMISSIONREQUESTLETTERANDFORM

[Adaptthislettertosendoutunderyourownletterheadwiththeaccompanyingform.Atthetopofthe
form,fillinthedescriptionoftheitemforwhichyouareseekingpermissionand,nearthebottom,your
proposedcreditline.Sendtwocopiesoftheletterandformtoeachrecipient,togetherwithaself
addressed,stampedenvelope.]
Dear[name],
Iamtheauthor[oreditor]ofthebook[title],tobepublishedbytheUniversityofBritish
ColumbiaPressin[seasonandyear].Iamwritingtoaskforyourpermissiontoreproducean
excerpt[oranillustration]inthispublication.
ThesourceinformationthatIhaveforthisexcerpt[orillustration]isasfollows:
[Foratext,givetheauthor,completetitle,completepublicationdetailsforthejournalorbookin
whichtheexcerptappeared,includingpagenumbers.Citethefirstandlastfewphrasesofthe
passageandindicatethetotalnumberofwords.]
[Foraphotograph,givethenameofthephotographerandabriefdescriptionofthesubjectofthe
photographor(whereapplicable)thecreatorandtitleoftheworkshowninthephotograph.For
anothertypeofillustration,suchasamapordiagram,orforatable,givecompletesource
informationasforatext,alongwithabriefdescriptionandthenameofthecreator,ifknown.]
Iamenclosingaphotocopyoftheexcerpt[ortheillustration].
TheUniversityofBritishColumbiaPressisanonprofit,academicpublishinghouse.[Booktitle]
isascholarlystudy,approximately[number]printedpagesinlength,whichwillbepublished
inaneditionof[number]copies.Itwillbesoldtolibraries,scholars,andinterestedgeneral
readers.
Iamrequestingpermissiontoreproducetheexcerpt[ortheillustration]inalleditionsand
formatsrelatedtothisbook,includingelectronic,forthedurationofthepublication,andin
printandonlineadvertisingandmarketingmaterialspromotingthebook.
Please note that a credit line will appear prominently in the book acknowledging
that the material is used with the permission of the copyright holder.
[IFAPPLICABLE]:Ialsorequestpermissiontoreproducetheillustrationonthecoverofthe
bookandinmaterialsadvertisingandpromotingthebook.
[IFAPPLICABLE]:Iwillreceivenoroyaltiesonthefirsteditionofthebook.]Iwouldbemost
gratefulifyoucouldwaiveanyreproductionfees;inreturnforthiscourtesy,Icanofferyou
onecomplimentarycopyofthebook.
Pleasecompleteonecopyoftheenclosedform,signit,andreturnittomeatyourearliest
convenience,togetherwithonecopyofthisletter.Thesecondcopiesoftheformandtheletter
areforyourrecords.Youmayfaxthecompletedformandlettertomeat[faxnumber].

Thankyouverymuchforyourhelpinthismatter.Ifyouhaveanyquestions,pleasecallmeat
[phonenumber]oremailyourqueryto[emailaddress].

Descriptionofitem:[asspecifiedonthefirstpageofthisletter]:

Pleasecompletethispageandreturnonecopytome,togetherwiththeattachedletter.A
secondcopyisenclosedforyourconvenience.
Pleasecheckone:
I/weclaimnorightsinthiswork.
OR
I/weclaimfullrightsinthiswork.
OR
I/weclaimonlythefollowingrightsinthiswork:

Forotherrights,pleasecontact(name):
(address):
Pleasecheckone:
I/wewaiveanyfee,inexchangeforonecomplimentarycopyofthebook.
OR
Thefeeforuseinthebookis$

,payableonpublicationofthebook.
Thefeeforuseonthecoveris$

,payableuponpublication.
Thefeeforuseinadvertisingandpromotingthebookis$

,payable
uponsuchuse.

Pleasecheckone:
Thefollowingcreditlineisacceptable[Applicant:insertproposedcreditlinehere]:
OR
I/wepreferthefollowingcreditline:

Foraworkofart,pleasespecifymedium,dimension,date,andlocation:

I/weherebygrantpermissionfortheuseofthisitemasoutlinedintheaccompanyingletter.
I/wewarrantthatI/wehavethelegalauthoritytogranttherightsspecified.

Signature:

Date: