Copyright Request Form

Request For Permission to Reproduce Copyrighted Materials
from Robert Dilts' Published Works

A signed authorization is required each time you want to use copyrighted materials.
To request to reproduce Robert Dilts' copyrighted materials, fill out the form below and send it, by clicking on the Send Email button at the bottom. Please limit your request to a small portion of any one publication, and submit your request at least one month before you need an answer.

(Guidelines for using Copyrighted materials)


Please provide the following information:

From: (your name please)

Address:

Email:

Phone:

FAX:

Title of publication from which you want to copy pages:


Page number or numbers of the material you plan to distribute:

To whom will you distribute this material?


Where will you distribute this material?


When will you distribute this material?


Approximately what percentage of your publication will this material provide? %

How many copies will you make of each page?

Total number of copies to be made:

Any other message:

If your request is approved, the copyright notice referencing Robert Dilts must appear on the bottom of each page. You can add "Reproduced with permission of the author," after receiving signed authorization.

(If this material is more than 10% of your publication, please send a copy of your whole handout or publication in which you intend to use the material.)


Security Check:

CAPTCHA Image       Reload Image
Audio     New Image



Enter Code:

Click here to when done.

Thank you.