Date:

To:

From:

The University of Georgia Press has accepted for publication my manuscript entitled __________________________________________.

Publication of the book is scheduled for __________________________________________.

I am requesting permission to reprint in English, for world distribution, the following material that appeared first in your publication:

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Please complete this form and return it to me so that I may forward it to the University of Georgia Press and the production of the book will not be delayed.

Sincerely,

On behalf of __________________________________________ I grant permission for the material listed above to be reprinted in English, for world distribution, in the original and all subsequent editions of the author's forthcoming book with the University of Georgia Press.

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Signature

__________________________________________
Date

Please indicate here if a particular credit line is to be used:

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