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Application Form for Print Permissions

(Please apply separately for each author whose work you wish to reproduce)

a) Individual or company to be invoiced (if a fee applies)

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Email Address: *

b) Individual to whom formal letter should be sent (if different)

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c) Details of the work in which the extract is to appear

Author:

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Publisher:

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Edition/s:

(eg hardback, paperback, book club, audio cassette, electronic)

Estimated print quantity of each edition:

d) Details of the extract you wish to reproduce

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Number of lines of poetry:

(please list each poem separately)

Language:

(if not English)

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Type the characters you see in the picture above; if you can't read them, submit the form and a new image will be generated. Not case sensitive.

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