• Copyright Release Statement

    Article Title _______________________________________________

    In compliance with the Copyright Revision Act of 1976, the undersigned author or authors warrant that they have sole ownership of the work submitted, that the work is original and has never been published, and that the author or authors have full powers to grant such rights.

    In consideration of APTA's magazine, PT in Motion, taking action in reviewing, editing, rewriting, abridging, condensing, and translating the submission, the authors undersigned hereby transfer, assign, or otherwise convey all copyright ownership to APTA, in the event that such work is published by APTA in PT in Motion [includes original photographs and art]

    Signature/Date ____________________________________________

    Signature/Date ____________________________________________

    Signature/Date ____________________________________________

    PT in Motion Media Release Form

    I hereby grant permission to the American Physical Therapy Association (APTA) to use my name and any images of my likeness in PT in Motion, in addition to any other media projects developed by APTA on the role of physical therapy in the health care delivery system.

    (please print clearly)

    Name ________________________________________________________

    Address ______________________________________________________

    City ______________________________ State ______ ZIP ________

    Phone _____________________________

    Signature/Date ________________________________________________

    Photographer _________________________________________________