Request for Permission
Total Page：16
File Type：pdf, Size：1020Kb
Request for Reprint Permission
Please complete this form and return by: 1) email: [email protected] 2) fax: 001 202-266-1900 or 3) Mail: Migration Policy Institute, c/o Permissions, 1400 16th St. NW, Suite 300, Washington, DC 20036
Date:
Your Name & Title (please print or type):
Name of company or organization requesting permission: Contact person’s E-mail: Phone Number: Fax: Website:
Address 1: Address 2: City: State/Province: Postal Code: Country:
USA Payee—Tax ID number: Non-USA Payee—W8-BEN number:
Request to reprint the following Migration Policy Institute Publication(s): Article: Title of Publication: Issue details (i.e. Month/Date): Source/URL from MPI/Source website:
Number of pages in article (please specify only if seeking to reprint a section of a larger publication):
Title of work in which the MPI material will appear:
Expected Date of reprint:
If applicable, language translations (MPI reserves the right to review translations):
Description of work in which the MPI material will appear or be used:
Type of Media: ____ Electronic (specify type (PowerPoint, Broadcast type, etc) : ______) ____ Website link (specify URL which MPI link or article will appear:______) ____ Course reader (Professor ______, Semester______Course name______, Approx.# of copies ______)
____ Publication (specify :______) Print Run ______Sales Price ______ISBN: ______
FOR INTERNAL USE [ ] fee assessed $______Invoice/Permissions Tracking #______