Journals Permission Form
American Mathematical Society
201 Charles Street
Providence, RI 02904-2294

To: _______________________________________________

From:  ____________________________________________

Date:  _____________________________________________

I am preparing the following article to be published by the American Mathematical Society, a non-profit organization dedicated to publishing research mathematics:

Title:  ______________________________________________

It will appear in  ______________________________________

Journal name:  _______________________________________

I am requesting permission to use and distribute worldwide in all languages and in both print and electronic media, the material described below, in all editions of the above publication. Proper credit will be given using the information that appears below. If you would like the Society to use a specific credit line, please supply the desired wording at the bottom of this page. 

Author(s) and/or Editor(s):  _______________________________________________

Complete citation (including page span and year of publication):   ________________________________

Figures/Photos/Tables: ____________________________________________________

Please sign below if you agree to the terms stated above. By your signature you indicate you are the sole owner of the copyright and that your material does not infringe upon the rights of any other party. If you do not
control these rights, please let me know to whom I should apply.

Specific credit line: ________________________________________________________


PERMISSION GRANTED:

_________________________________________________________________
Publisher/Copyright Holder

_______________________________
Date