PERMISSION REQUEST FORM

Date:_____________________

Send To: Permissions Editor

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Return to:

American Geophysical Union
Books Department
2000 Florida Avenue, NW
5^th Floor
Washington, DC 20009 USA

I am preparing material for:

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title of chapter

to be published by the American Geophysical Union, a nonprofit organization. I would like to include the following material from your publication in the AGU chapter noted above and future editions and revisions thereof, including worldwide rights in print and other formats:

Your Publication (title, description of material, figure/table number, page numbers)

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Will be identified as Figure/Table/Plate in AGU Publication (title, description)

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Please sign this release form below, keeping a copy for your files and returning the original to me. If you have a preferred credit line, please list here:
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Suitable credit will be given for the use of the material. Your consideration of this request at your earliest convenience will be appreciated.

Signed:________________________________

I (we) hereby grant permission for use of the above-mentioned material.

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Authorized signature

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Position

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Date

Permissions Editor, Please check: Copyright owner is __publisher __author __photographer __other

AGU AUTHOR: Reproduce and use one form per figure/table request.