AACC S Lab Tests Online 1

AACC’s Lab Tests Online 1

Intellectual Property Use Request Form

Lab Tests Online®

Intellectual Property

Third-Party Use

Request Form

Thank you for your interest in AACC’s Lab Tests Online®.

Please complete the information below so that we can better understand your request.

Date: ______

I. Company Information

Submitted by: ______

Title: ______

Company/Organization: ______

Address: ______

City/State: ______

Zip: ______

Country: ______

Phone: ______

E-mail:______

URL:______

Identify your company as:  Commercial  Not-for-profit

Enter your EIN/TIN: ______

Please describe your business concept and products and/or services you offer:

______

______

Please describe your target market(s) and customers:

______

______

If your company is a lab, please indicate the volume of tests performed annually and information on the accreditation:

______

______

II. Type of Request

Is this a request to:

License

(see Section III)

Reprint 

(see Section IV)

Other (e.g., link or use of logo)

(see Section V)

------For License Requests------

III. Details of Request

A. Please identify the specific intellectual property that you are interested in licensing.

What content areas?

 Test articles Condition/Disease articles Screening articles

Feature articles News articles

 Other (specify) ______

B. Will you want to licenseALL of thearticles currently found in the requested content area(s)?

 Yes No

If no, specify exactly whicharticlesyou are interested in licensing (include titles and/or URLs)?

Enteron another sheet if necessary.

______

______

______

C. Will you want to receive new and/or updates to articles in the selected content areas during the duration of the period of use?  Yes No

D. Please describe how and why you would like to license AACC’s Lab Tests Online® intellectual property:

(Include where and how the information will be featured, is it for print or electronic distribution,who you expect to access it, how many people you expect to access it, and your objective in featuring the content and reaching the audience. Examples or mock-ups are encouraged.)

______

______

______

______

______

E. Please describe the revenue model that will support your site/publication.

______

______

______

______

______

F. Will you charge a fee for access to the intellectual property?  Yes  No

G. Will you receive fees from any other party to fund your purchase of the intellectual property (if applicable) and/or post/provide access to it?  Yes  No

If so, please specify name of business/entity, nonprofit/for-profit status and fees charged:

______

______

______

H. Time period during which you would like to license this intellectual property:

Start Date: ______End Date: ______

I. Lab Tests Online frequently updates its pages as new research and technology advances warrant. What is the expected shelf-life of the products in which you plan to incorporate AACC’s Lab Tests Online® intellectual property?

A statement is required alerting readers that updated content can be found at labtestsonline.org.

J. Describe how the use of AACC’s Lab Tests Online® intellectual property would benefit your company:

______

______

______

______

K. Describe how your use of AACC’s Lab Tests Online® intellectual property would benefitLab Tests Online®:

______

______

______

______

------For Reprint Requests------

IV. Details of Request

A. Please identify the specific intellectual property that you are interested in reprinting.

What content areas?

 Test articles Condition/Disease articles Screening articles

 Feature articles News articles

 Other (specify) ______

B. Will you want to reprint ALL of the articles currently found in the requested content area(s)?

 Yes No

If no, specify exactly which articles you are interested in reprinting (include titles and/or URLs)?

Enter on another sheet if necessary.

______

______

______

C. Please describe how and why you would like to reprint AACC’s Lab Tests Online® intellectual property:

(Include where and how the information will be featured, is it for print or electronic distribution, who you expect to access it, how many people you expect to access it, and your objective in featuring the content and reaching the audience. Examples or mock-ups are encouraged.)

______

______

______

______

D. Please describe the revenue model that will support your publication.

______

______

______

______

______

E. Will you charge a fee for access to the intellectual property?  Yes  No

F. Will you receive fees from any other party to fund your purchase of the intellectual property (if applicable) and/or post/provide access to it?  Yes  No

If so, please specify name of business/entity, nonprofit/for-profit status and fees charged:

______

______

______

G. Time period during which you would like to use this intellectual property:

Start Date: ______End Date: ______

H. Lab Tests Online frequently updates its pages as new research and technology advances warrant. What is the expected shelf-life of the products in which you plan to incorporate AACC’s Lab Tests Online® intellectual property?

A statement is required alerting readers that updated content can be found at labtestsonline.org.

I. Describe how the use of AACC’s Lab Tests Online® intellectual property would benefit your company:

______

______

______

______

J. Describe how your use of AACC’s Lab Tests Online® intellectual property would benefit Lab Tests Online®:

______

______

______

______

------For Other Requests------

V. Details of Request

A. What are you requesting?

 Use of Lab Tests Online logo

 Linking to Lab Tests Online

 Both

 Other (specify) ______

______

B. Please provide additional details related to your request such as the following:

(Include where and how the information will be featured, is it for print or electronic distribution, who you expect to access it, how many people you expect to access it, and your objective in featuring the content and reaching the audience. Examples or mock-ups are encouraged.)

______

______

______

______

______

C. Time period during which you would like to use this [logo, link or other]:

Start Date: ______End Date: ______

D. Describe how the use of AACC’s Lab Tests Online® [logo, link or other] would benefit your company:

______

______

______

______

E. Describe how your use of AACC’s Lab Tests Online® [logo, link or other] would benefit Lab Tests Online®:

______

______

______

______

Thank you.