Reprint Permissions

All of the below options marked with a red asterisk (*) must be completed to submit a requst for reprint permission.

*Name of Requestor


*Company (name/address/state/zip/country)


*Phone Number


*Fax Number




*Title of APTA Publication


*Article Title


*Volume/Issue, Number/Year/Page Numbers (all that apply)


Figures/Tables Numbers (if applicable)

*Title/Type of Publication or other vehicle in which APTA material will appear (eg., journal, book, brochure, Web-site, CE course, presentaton, classroom curriculum)


*Estimated size and Demographic of Audience, or Print Quantity of Publication


*Scope of Permission (Please click on all that apply)

*Requestor is an Author of the Material Being Sought:

*Will publication be distributed for resale?

If material is to be adapted, provide the proposed revised text or graphic via fax, e-mail, or mail.

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Alexandria, VA 22314-1488

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