AMERICAN PSYCHIATRIC PUBLISHING, INC.
REQUEST FOR PERMISSION TO REPRINT TEXT FROM APA/APPI BOOKS AND JOURNALS INCLUDING ALL EDITIONS OF THE DSM
 

PART I. Contact Information:

Name of Person Making the request: 
Name of Company or Organization:
Complete mailing Address:  
Email Address for Contact Person:
Telephone Number for Contact Person: 
Facsimile Number for Contact Person: 
 

PART II. Material to be Reproduced:

Book or journal name: 
Book chapter or journal article title:
Table number and title:
Page number: 

(Note: Sections of DSM-IV-TR that may NOT be reprinted include complete chapters or Appendices A, G, and H.)
 

PART III. Description of Your Proposed Product:

Please provide a general description of your proposed Product and then answer the specific questions below. Please attach to your request sample pages or a copy of the proposed Product or a more detailed description.



Attachment:

Is your product a printed publication or an electronic product or both?
If printed, is your product a journal article or a book ?
In which countries are you planning to distribute your product?
For Print Products
Title:
Author:
Number of Copies to Print:
Unit Retail Price:
For Electronic Products
Will it be available on a CD-Rom or LAN/WAN database (specify)?
How many users can be expected to access each product?
Will product be resold?
Will there be a one-time fee for unlimited use, a subscription based fee, a user-based fee, or an access-based fee for each use, or other fee (specify)?
For Electronic Products
Will the APA/APPI material be published on the Internet?
If so, will access be restricted (specify)?
 

PART IV. Acknowledgements and Signature:

I acknowledge that submission of this Request for Permission or receipt of a permission fee quote does not constitute permission, and that any use of any copyrighted text owned by APA or APPI is unauthorized unless and until I am in receipt of a signed Permission letter or Electronic Product License Agreement.

I further acknowledge that my proposed use may be such that I may be required to enter into an Electronic Product License Agreement in APA or APPI's sole discretion.

I further acknowledge that if any usage or administrative fees are assessed by APA or APPI, the signed permission may be withheld until such fees are paid.


  Disagree       Agree
 




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