We Request the Following Form Be Completed by the Applicant BEFORE Reproducing Any Article

Dearapplicant,

We request the following form be completed by the applicant BEFORE reproducing any article or part of an article from the International Heart Journal (IHJ) or its predecessor Japanese Heart Journal (JHJ). Please specify theyear; volume: page, author(s), title of the article, and which figure(s) and/or table(s) you want to reproduce. You mustalso describe the intended use.

For the duplication of an article or portion thereof that is protected by copyright possessed by the International Heart Journal(formerly Japanese Heart Journal) Association, the following are required:

1) A completed Permission Form signed by the applicant should be sent by mail to the IHJ Association.

2) All material, including tables and figures, should be accurately reproduced and a proper citation should be clearly acknowledged and displayed in the duplicated article.

3) Two copies of ALL materials (articles, figures, tables, etc) to be duplicated should be sent to us by mail after publication.

4) A royalty fee must be paid to us (no fee is required for academic uses).
Please clearly state the intended purpose. We will determine the fee to be paid based on this information.

Duplication fee is to be calculated as follows:

Purpose of use / Fee
Academic / Free
Non academic / Number of copies / ≤ 10,000 / JPY 10,000
> 10,000 / JPY 30,000
on website including intranet / JPY 30,000

Application for Permission for Reproduction from International Heart Journal

(Formerly Japanese Heart Journal)

Applicant

Name

Affiliation

Address

Permission is granted for reproduction of the following figure/table from International (Japanese) Heart Journal according to the listed conditions.

Year; volume: page: Vol. No. p -

Author(s):

Title of Article:

Figure/Table number:

Conditions : For use in

Issei Komuro, MD

Editor-in-Chief, International Heart Journal

Application form for duplication of materials whose copyright is held by International Heart Journal

We hereby acknowledge thatobtaining permission for duplication of an article does not prohibit the copyright holder (IHJ) from granting permission to another applicant or publisher. We agree to duplicate all materials accurately, including tables and figures, and we agree toproperly and clearly acknowledgeInternational Heart Journal in the materials duplicated.

We hereby have enclosed a completed and signed permission form.

Applicant Signature

Permission form for duplication (permission from the IHJ Association)

Title of the Article:

International Heart Journal agrees to the applicant’s citation of a part or the entirecontents, including tables and/or figures, of the above article that was previously published in International Heart Journal (Int Heart J Vol. No. p. - ).

Issei Komuro,MD

Editor-in-Chief, International Heart Journal