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Gottesman Research Library and Learning Center

Scientific Publications Permission Form

Questions marked with * are required.

1. Name: *

2. Email: *

3. Address Line 1: *

4. Address Line 2: *

5. Address Line 3:

6. Phone: *

7. Fax:

8. Publication *

9. If other, please specify:

10. Series/Volume Number: *

11. Article Name: *

12. Author: *

13. Figure/ Page Number(s): *

14. Detailed Description of Planned Usage: *