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Journals Permission Form

American Mathematical Society
201 Charles Street
Providence, RI 02904-2294

To [copyright holder]: 

      Name: _______________________________________________

      Email address: ________________________________________

      Address:  _____________________________________________
                        _____________________________________________
                        _____________________________________________


From [author]: 
 
      Name: _______________________________________________

      Email address: ________________________________________


Date:  ___________________________________________________________

I am preparing the following article (the 'Work') to be published by the American Mathematical Society, a non-profit organization dedicated to the mathematical research community:

Title:  ___________________________________________________________________________

It will appear in 

Journal name:  ____________________________________________________________________

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):  ___________________________________________________________

Complete citation (including page span and 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:

_________________________________________________________________           
Publisher/Copyright Holder                                                                                                                 

_________________________________________________________________           
Printed Name

_______________________________
Date


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