Association of College Unions International

Request for Republication Permission

 

This form seeks permission for one-time republication of a document owned by the Association of College Unions International.

 

Date of request          ________________________

 

 

Document information

 

Title of document          ______________________________________________________

 

Author of document      ______________________________________________________

 

Original date of publication        ________________________ Page number ____________

 

Explanation of use         ______________________________________________________

 

______________________________________________________                                   

 

 

Person requesting permission

 

Name                           ______________________________________________________

 

Street address              ______________________________________________________

 

City/State/Zip Code      ______________________________________________________

 

Phone number              ___________________ E-mail address ______________________

 

 

Please return this form with republication fee to:

 

Elizabeth Beltramini, ACUI

One City Centre, Suite 200

120 W. Seventh St.

Bloomington, IN 47404

 

 

Please make a check out to the Association of College Unions International or complete the following information:

 

Credit Card No. __________________          _ Exp. ___________

 

Name on card ___________________           Signature _________              __________

Updated March 7, 2007