Copyright request form

The fields with a asterix (*) next to them are mandatory.

Your contact details

Name *

Business/organisation: *

Email: *

Phone: *

Address *

Details of DPIRD document or image you or your organisation wishes to reproduce

Title *

Author

Series name (e.g. PestNotes, Bulletin)

Series number

Year of publication *

ISBN, ISSN or catalogue no.

Is the work to be reproduced in its entirety, including accompanying images, graphs, tables, photographs or drawings?

Yes

Describe the graphs, photos, tables or drawings to be used if they are to be reproduced separately

If the item is from our website, please paste the web address here:

Please state the intended purpose of reproduction (e.g. use in the publication title, Vol X, Issue No X, 2013 or course name and year) *

Number of copies to be reproduced

Or is it for online access?

Is this for free issue?

Yes

Is this for sale at cost recovery? (for educational institutions only)

Yes

Is this for commercial use?

Yes

Please detail special requirements (e.g. high quality versions of photographs required)

Leave this field blank

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