Reprint Permissions Request Form

Use this form to seek permission from the AsMA if you would like to reproduce, reprint or adapt content from the AsMA Web site or the journal Aviation, Space, and Environmental Medicine. For complete information, please see the permissions page.

Contact Information

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If yours is a not-for-profit organization, is there sponsorship associated with your project?

Yes

If yes, by what organization?

Organization Type*

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Managed Care Plan (HMO, PPO, POS, etc)

Pharmaceutical

Medical School / University/ Residency

Education Firm

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Content you wish to use

Title *

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Entire Article

Table / Figure

Illustration/ Photograph/ Radiograph

Please identify the material you wish to use *

(Ex: Figure 1 or Table 1 or a specific section)

Publication title and/or web address *

Journal Volume

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Intended use of AsMA content *

Photocopy for Presentation/ Syllabus

Reprint ( in book/ journal/ magazine/ newsletter

CD-ROM

Internet

Translations List Languages

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Requester's publication title *

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