Permission to Photocopy Request Form

For administrative purposes, please submit this form one week in advance of requested use date.

Fax to: (613) 258-0864

Mail to: 
	The Canadian Biodiversity Institute
99 Fifth Avenue, Suite 322
Ottawa, Ontario, Canada
K1S 5P5

STEP ONE: PROVIDE CONTACT INFORMATION:

Title:

First name:

Last name:

Profession:

Affiliation (school, group, organization, etc.):

Street address:

City:

Province/State:

Postal code:

Telephone:

Fax:

E-mail:

STEP TWO: PROVIDE INFORMATION ON MATERIAL YOU WISH TO COPY:

Website address:

Title/s of webpage/s:

Section/s of webpage/s:

STEP THREE: PROVIDE PURPOSE FOR COPYING MATERIAL:

The material is to be  used for the following purpose:

If the material is to be used for presentations or workshops, how many events will it be used for?

Date/s of presentations or workshops:

Total number of copies to be made:

How will the copies be distributed?

STEP FOUR: ACKNOWLEDGEMENTS:

Permission to copy material from this website is granted only upon the understanding of the person or persons requesting permission to copy that the Canadian Biodiversity Institute and the School Grounds Transformation website from which the material has been copied is identified as the source on all copies and all copy sets.

STEP FIVE: AGREEMENT

I have read and agree to comply with the Canadian Biodiversity Institute’s Permission to Copy requirements.

The Canadian Biodiversity Institute’s School Grounds Transformation website will be indentified as the source of all material copied from this website for the purpose/s described in the completed Permission to Copy form and will be identified on all copies and all copy sets.

Name of Organization:

Name of person authorized by the organization to submit this form.

If mailed or faxed, please print the name and add the signature of the person authorized to submit this form.

Date: