Form "B"

Request for Copy Service

The Copyright Law of the United States (Title 17, U.S.C.) governs the making of photocopies or other reproductions of copyrighted materials. I understand that the unauthorized use of copyrighted materials is a violation of law for which I may be libel. Therefore, before the Medical College of Georgia Bookstore will reproduce any materials, the faculty member, employee or student presenting materials, must complete and sign the form below. I hereby request that the Medical College of Georgia Bookstore reproduce the following materials for my students:

I affirm that (check those which apply):

______ The materials listed above are not protected by copyright laws of the United States.
______ I have obtained from the holder of the copyright, permission to reproduce ______ number of copies of this work for my intended purpose.
______ I have read the guidelines on use of copyrighted materials for educational purposes and I certify that my request for photocopying of these works for my intended purposes falls within these guidelines.

I understand that by signing this document, I am accepting responsibility for any violations of copyright law that the reproduction of these materials may entail.

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Signature
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Date

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