A Subsidiary of the American Hospital Association

155 N. Wacker Drive – Suite 400

Chicago, IL 60606

P E R M I S S I O N T O R E P R I N T
American Organization of Nurse Executives (AONE),

a subsidiary of the American Hospital Association

NAME AND ADDRESS OF PERSON MAKING REQUEST:

Name:
Address:
City: / State: / Zip:

The undersigned requests permission to reproduce material from

Title:
Author:
Published In:
Date:

I.This material will be reproduced in the following way(please indicate one):

Reprinted in a work(examples include: chapter in a text book, research article, course curriculum, etc.)

Work entitled:
Written by:
To be published by:
Estimated publication date and/or edition:

Reproduced as freestanding material

To be distributed free/at cost/as part of a registration fee/at a charge of $ per copy.

II.Prior to usage and before approval is granted, one sample copy must be sent to the American Organization of Nurse Executives (AONE), 155 North Wacker, Suite 400, Chicago, IL 60606 (c/o Susan Gergely, Chief Operating Officer).

III.When material is produced, one copy must be sent to the American Organization of Nurse Executives (AONE), 155 North Wacker, Suite 400, Chicago, IL 60606 (c/o Susan Gergely, Chief Operating Officer).

IV.AONE will supply copy written material directly to applicant for inclusion in his/her publication. Please indicate the file format you prefer to receive this content (ie, JPEG, PDF, etc.) AONE will do their best to accommodate this request.

V.In addition to the stipulations above, the undersigned agrees to the following additional

stipulations that apply to reprints of AONE material:

1.The following credit line, including copyright notice, will appear on the first page of reprinted material:

2.No writing or printing other than the credit line may appear, except that the credit line may be followed by a comma, the word by and the name of the requester producing the reprint.

3.Reproduction will follow text exactly. No changes, deletions, or additions will be made without specific permission.

4.No advertising matter may be attached. Any advertising appearing on the same page as the text to be photocopied must be covered or cut out before photocopying the text. In such an instance, the text columns may also be rearranged.

5.This permission does not include any grant of copyright matter obtained by AONE from other sources incorporated in the material specified. No rights other than the reprint of the specified materials are conveyed in this permission agreement.

This letter, when received by the American Organization of Nurse Executives (AONE), with both signatures serves as a contract setting the terms on which the material may be used.

Accepted: AONE APPLICANT

By:

Date: