Form "C"
Month Day, Year
John Q. Publisher
Publishers & Company
New York, New York 10101
Dear Mr. Publisher:
I would like permission for the Medical College of Georgia to duplicate the following work:
| Author: | Robert J. Levine |
| Title: | Ethics and Regulations of Clinical Research, 1981 |
| Copyright: | 1981 |
| Material to be duplicated: | Pp. 74-93; P. 291, "Appendix 5" |
| Number of Copies: | 75 |
| Form of Distribution: | supplied to professors requesting information and occasional seminars |
| Type of reprint: | Photocopy |
The information above will be used as a supplemental reading for a seminar on Research Ethics in Medicine. Enclosed is a self-addressed envelope.
Sincerely,
Dr. Jekyll
Medical College of Georgia