Permission to reprint or republish by a commercial publisher:

A commercial publisher may use up to 25% of an article in a
	re-publication by completing this form. If your company wants to
	reproduce more than 25%, you must send such a request by certified
	mail to Molecular Vision, C/O John Nickerson, B5602, Emory Eye
	Center, B1365B Clifton Road, NE, Atlanta GA, 30322.

If you are re-publishing these materials Open Access, then you may
republish up to and including the full article by completing this Form.
[You must adhere to AT-BY of the CCL 3.0 licenses.
http://creativecommons.org/licenses/by-nd/3.0/.]


1. What Materials do you want to use? IE, Figures 1-2, Tables 3-4, text,
Abstract, Appendix, etc. 

______


2. Identify the Molecular Vision article from which you want to
republish.  By authors____. entitled ____. year____; vol____: pages____. 


3. Who are you? Provide your business contact information:

Name 		_____
address 	_____
email address 	_____
office phone 	_____ 
FAX 		_____


4. What publications do you represent? 

Name(s) of company(ies)  _____


5. In what publication do you want to republish the Mol Vis content? 

Full Authors ____, 
full editors ____, 
book title ____ , 
book chapter or article title ____, 
journal name ____ 
proposed publication date ____.


6. Is this publication Open Access?  Yes/No.


7. Certification:  I, {___Full name here___}, as an authorized
representative of  {__Full company name here___}, agree to the terms of
this agreement dated, {__Month/day/year___} .

	Our company, {company name here}, will cite the original work, and
identify Molecular Vision as the original publisher. We will include a
statement to the effect, "Courtesy of the authors and Molecular Vision.
Copyright by the Authors (--year--). The work was originally published
in Authors, Title, Mol Vis, (year); vol: pages-pages." 
	We will not re-use or redistribute this work in any additional
publication without seeking permission again. We will contact the
authors of this article separately, and we will not proceed until they
have authorized republication.

Signature, date.


8. Complete this document on company letterhead, sign it, scan it, and
email it as a pdf attachment to John Nickerson at litjn@emory.edu.

9. You may proceed once Dr. Nickerson responds in the affirmative.