Publication Permissions Form

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Requestor Information

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GPG title from which you wish to reprint:

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Year

Volume

Number (for Journals)

Edition

This GPG material will be copied/rebound with other prints for

Course Title

Semester

Instructor

Institution

Anticipated Enrollment

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I Will Use the GPG Material in the Following Formats/Media Types

Print Only (e.g. Photocopies)

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