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Permission Form

American Mathematical Society
201 Charles Street
Providence, RI 02904-2294
FAX: 401-331-3842

To: [COPYRIGHT HOLDER - include address, and email]

From: [AUTHOR - include address and email]]

Date:

I am preparing the following [BOOK/PROCEEDINGS ARTICLE/JOURNAL ARTICLE] to be published by the American Mathematical Society, a non-profit organization dedicated to the mathematical research community:

 Title:  
   For a book: ["TITLE"]
   For a proceedings article: ["TITLE OF PAPER", to appear in TITLE OF VOLUME, edited by LIST OF EDITORS]
   For a journal article:  ["TITLE OF PAPER", to appear in TITLE OF JOURNAL]


I am requesting permission to include in this and all future editions of the Work the material described below, free of any restrictions which might limit the publisher's ability, itself or through licensees, to produce, publish, promote, and distribute the Work in any territory, any language, and any medium now known or hereafter discovered.  This material may appear within the text or on the front or back cover of the Work.  Proper credit will be given using the information that appears below.  If you would like the Society to use a specific credit line, please so note at the bottom of this page.

Author(s) and/or Editor(s):

Citation (include page span & year of publication):

Figures/Photos/Tables:

Please sign below if you agree to the terms stated above. By your signature you indicate you are the sole owner of the copyright and that your material does not infringe upon the rights of any other party. If you do not control these rights, please let me know to whom I should apply.

Specific credit line: __________________________________________________________________________________


Permission granted:
 
 
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Publisher/Copyright holder                                                 
 
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Date