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Request for Permission to Republish

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									UNIVERSITY OF CHICAGO PRESS Permission Department 1427 E. 60th Street Chicago, Illinois 60637 Fax: (773) 702-9756 / permissions@press.uchicago.edu

Request for Permission to Republish University of Chicago Press Material
Thank you for your interest in republishing material from the University of Chicago Press. Please complete this form in full and submit it by mail, e-mail attachment, or fax; we must have all of this information in order to respond to your request. A. My contact information: Name: Organization: Title: Address 1: Address 2: City: Phone:

State/Province: Fax:

Postal Code: E-mail Address:

Country:

B. The material from Part C (see below) will be used in this forthcoming publication: Author/Editor/Organization: Title of Book/Journal: Title of Chapter/Article: Other republication (e.g., Intranet, Web site): Publisher: Planned Length of Book/Article: words Planned Publication Date: Countries of Distribution: Languages of Publication: Please describe any other format you intend to use, the pricing for that format, and the anticipated units disseminated. If you seek to license content for an intranet, define the scope of the audience, the access control mechanism, the length of time, and the address for the intranet. Formats:
Check if license is sought for a format and provide information on pricing and sales projections.

Format Hardcover Paperback Book club Audio recording Electronic text-storage media, not database Electronic database (multiple works combined)

U.S. Price

Lifetime Sales, est.

C. I wish to use the following material copyrighted by the University of Chicago Press [complete for each publication you wish to use in the project identified in Part B.]: Title of Book/Journal: Title of Chapter/Article: Author/Editor: ISBN/ISSN: Year of Publication: Edition and Issue: Copyright line from source: © Page(s) on which material is found (list page numbers): Description of text passage(s) to be included: Total word count of text: Total number of illustrations (figures, images, charts): Identification of each illustration [Please submit photocopies of these illustrations.]:
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Title of Book/Journal: Title of Chapter/Article: Author/Editor: ISBN/ISSN: Year of Publication: Edition and Issue: Copyright line from source: © Page(s) on which material is found (list page numbers): Description of text passage(s) to be included: Total word count of text: Total number of illustrations (figures, images, charts): Identification of each illustration [Please submit photocopies of these illustrations.]:
testtesttesttesttesttesttesttesttesttesttesttesttesttesttesttesttesttesttesttesttesttesttesttesttesttesttesttesttestt esttesttesttesttesttesttesttesttesttesttesttesttesttesttesttesttesttest

Title of Book/Journal: Title of Chapter/Article: Author/Editor: ISBN/ISSN: Year of Publication: Edition and Issue: Copyright line from source: © Page(s) on which material is found (list page numbers): Description of text passage(s) to be included: Total word count of text: Total number of illustrations (figures, images, charts): Identification of each illustration [Please submit photocopies of these illustrations.]:
testtesttesttesttesttesttesttesttesttesttesttesttesttesttesttesttesttesttesttesttesttesttesttesttesttesttesttesttestt esttesttesttesttesttesttesttesttesttesttesttesttesttesttesttesttesttest


								
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