Request to reproduce copyrighted materials

 

1. Name and address of individual/group making the request for permission to copy.

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  * Fields with an asterisk require an answer.
 

2. Please describe the Heart & Stroke material you wish to reproduced (include URL if available).

   


   


   


   


 
Question - Not Required - Type of Resource:







 

3. Please describe how the material will be used.

 

(Maximum response 1,000 characters)

   


   


 

4. Source of other information in the resource

 

(Maximum response 1,000 characters)

 

5. Please provide other details on the material being produced.

   


 
Question - Not Required - Will material be sold?


   


 
Question - Not Required - Will you be realizing a profit?


 

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