The Journal of Toxicological Sciences

Copyright Permission Request Form

(Please send this Form to the Editorial Office by E-mail or FAX)

Date:

To: Editorial Office

The Journal of Toxicological Sciences

Laboratory of Environmental Health

Faculty of Pharmaceutical Sciences

Tokyo University of Science

2641 Yamazaki, Noda278-8510, Japan

FAX: +81-4-7121-3621

E-mail:

From:

Name:

Address:

FAX:

I am preparing a paper entitled:

To appear in a (circle one) book, magazine, journal, proceedings, other

entitled:

to be published by:

I would appreciate your permission to use the following material:

The Journal of Toxicological Sciences

Vol. , No. , Page(s) , Year

==============================================================

This space is reserved for The Japanese Society of Toxicology Use

Permission to reprint is granted by the The Japanese Society of Toxicology

Approved by , Date

(Editor-in-Cheif)

==============================================================