Fill out this form to receive copyright approval.

IMPORTANT NOTE: Please complete this form only if you are requesting to reproduce any GOLD material and are seeking permissions. If you are looking for any copies of the GOLD Report, please visit GOLD REPORTS. You may download one copy for personal use there.

Name (required)

Address (required)

Your Email (required)

Organization Represented (if any)

Is commercial support involved directly or indirectly in the proposed use
YesNo

Indicate the GOLD document and pages, table or figures that you wish to reproduce

Indicate the proposed use of the materials: including the form(s) in which it will be disseminated, the number of copies that will be distributed, and whether or not a commercial organization will be using the material.

Will a commercial organization (for example a Pharmaceutical or Publishing Company or a Commercial Agency) provide funds for the dissemination, or if funds for the dissemination come from a professional group, will this professional group receive commercial funds for the activity?

If used for commercial purposes, will you provide a copy to GOLD prior to its release?
YesNo

Will the GOLD material be submitted for publication in a medical journal? If yes, please indicate the name of the journal.

Will there be any charge made for the disseminated document that includes the GOLD material?