Copyrighted Material Guidelines and Permission Request Form

Permission to copy, download, distribute or print EPI copyrighted material to the following conditions:

1. Copyrighted materials must be used solely by the requesting party during the usage dates requested for the intended use outline in this document.

2. Copyrighted materials may not be modified or be posted on the Internet without written approval.

3. Permission does not extend to materials owned by other content providers that appear on our Website or in our newspapers.

4.All requests must be signed and authorized by EPI (below) to be approved.

Requested material to be used:
Reporter/Author/Photographer: Reporter/Author/Photographer: First Last
Published Date: Published Date: / MM / DD YYYY
Intended use of material:
Usage dates:
Will this material be sold?
Number of copies for this purpose:
REQUESTER INFORMATION
Requester name: Requester name: First Last
Title:
Company/Organization:
Address: Address:
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone: Phone: - ### - ### ####
Email:
Digital signature: Digital signature: First Last
Date: Date: / MM / DD YYYY
My signature above indicates that I agree to comply with the usage guidelines in this document.

Copyrighted Material Guidelines and Permission Request Form

Copyrighted Material Guidelines and Permission Request Form

REQUESTER INFORMATION

My signature above indicates that I agree to comply with the usage guidelines in this document.