Percussive Arts Society Reprint Permission Request Form

Request Dates

Date of Request

Date of Proposed Reprinting

Contact Information

Name of Organization

Contact Person

Title

E-mail

Phone

Fax

Address

City, State/Province, Zip/Postal Code

Material to be Reprinted

Include title(s), author(s), publication, volume and issue.

Purpose for Reprinting

Do you personally or does your organization stand to make a profit by using this reprinted material?

YesNo

If yes, explain

By signing below, I am confirming that the information on this application form is accurate to the best of my knowledge. I also understand that, if granted permission to reprint, this is a one-time reprinting permission and I will contact the Percussive Arts Society if I desire to again reprint this or any other PAS material. I will give the following credit to PAS: “First appeared in Percussive Notes. Reprinted by permission of the Percussive Arts Society, Inc., 127 E. Michigan Street, Suite 600, Indianapolis, IN 46204; E-mail: percarts@pas.org; Web: www.pas.org” and I will send a copy of the entire published work to PAS no later than 30 days after the project is complete.

Applicant Signature

Name

Date

Contact Information