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Agreement To Reprint Copyrighted Material

(by non-profit organization)

This Agreement is by and between {NAME/ADDRESS OF COPYRIGHT HOLDER}, hereinafter referred to as {HOLDER}, and {NAME/ADDRESS OF NON-PROFIT ORGANIZATION}, hereinafter referred to as {ORGANIZATION}, on this ______ day of ______ 20 __, do hereby agree to the following:

RECITALS

{ORGANIZATION}, is preparing education materials for the purpose of teaching (subject of teaching). The foregoing mentioned instruction materials will be used (for and/or in)

(describe the foregoing)

and will be produced in (number) (books/volumes) copies.

DISTRIBUTION

The total distribution is expected to be approximately ( ) copies. The finished material on the entitled (title) subject matter herein, will be distributed without profit or personal gain of any form whatsoever. In light of the above mentioned guidelines, {ORGANIZATION} does hereby request permission from {HOLDER} to reprint the following material:

(describe)

In addition, {ORGANIZATION} will include a credit line in the (preface/reproduction) which states the following:

This material was reprinted from (name of original publication), with permission from (copyright holder/owner). Copyright (year). With the signing of this document permission is hereby granted to {ORGANIZATION} to reprint the previously mentioned copyrighted material.

This agreement is the entire agreement between the parties, and may only be altered by an instrument in writing.

Executed on the date as first above written at (City/State).

SIGNED:__________________________

{COPYRIGHT HOLDER/OWNER}

SIGNED:__________________________

{ORGANIZATION}