Reprint Permission Form

Thank you for your interest in reprinting material created by Caregiver Action Network (formerly National Family Caregivers Association). Your request for reprint permission will be considered upon receipt of this form. Please read both pages carefully. For non-profit organizations only, CAN may choose to waive its licensing fees for posting our content to other websites.

Date _______________________
Name ________________________________________________________________________
Title _________________________________________________________________________
Organization __________________________________________________________________
Address ______________________________________________________________________

City ________________________________________State _______Zip Code _____________

Phone __________________ Fax _______________ Email ____________________________

Are you or your organization a member of CAN?              □ Yes                     □ No 
URL of Tool, Publication, or Article you wish to reprint (use separate form for each)

_______________________________________________________________­­­­­_______________
______________________________________________________________________________

Title and description of location (i.e. organization newsletter, website, special report) where CAN material will appear: _______________________________________________________

Estimated audience size and composition:____________________________________________

For materials to appear in printed format: 
Upon CAN approval of this application, you will be granted one time non-exclusive North American rights to reprint the item specified above.

All material must appear exactly as originally printed unless approved in writing by CAN. If the material is to appear within another article, or as a shortened version of the original, CAN must see how the material is to be used before we can consider your request. We want our information to reach the widest audience possible, but we also want to make sure that it is being communicated as intended.

Credit line must read: Reprinted from CaregiverAction.org by permission of Caregiver Action Network, the nation's leading organization for all family caregivers.
www.CaregiverAction.org
  
CAN must receive a complimentary copy of the publication containing the reprinted material.

For materials to appear in electronic format: 
Upon CAN approval of this application, you will be granted permission to keep specified CAN content on your website for a period not to exceed 6 months. NOTE: For non-profit organizations only, CAN may choose to waive its licensing fees for posting our content to other websites.

As noted above, material must appear exactly as originally published on CaregiverAction.org  unless approved in advance in writing.

Credit line must read: Reprinted from CaregiverAction.org by permission of Caregiver Action Network, the nation's leading organization for all family caregivers. www.CaregiverAction.org (must be hyperlink)

I hereby agree to abide by the conditions of the above agreement:

_____________________________________________________________        ____________________
Signature                                                                                                                             Date

____________________________________________________________________________________

Print Name (exactly as signed)                                                 Title

Approval granted by CAN:

__________________________________________________________    __________________

Signature                                                                                                                             Date

______________________________________________________________________________

Print Name                                                                             Title

(Rev. 10/15)