Copyright Request Form - Global Initiative for Chronic Obstructive Lung Disease

Name
First Last
Address*
Email*
Organization Represented (if any)
Is commercial support involved directly or indirectly in the proposed use?*
- Yes
- No
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?
- Yes
- No
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?*
- Yes
- No
CAPTCHA
Name
This field is for validation purposes and should be left unchanged.