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