Province of British Columbia

To receive permission to reproduce all or part of a provincial publication or Web site, please complete the following form. To help us process your request in the most timely manner possible, please be sure that the information you provide is both accurate and complete.

For further information about copyright, refer to the Intellectual Property Program home page at www.ipp.gov.bc.ca.

Any fields marked with an asterisk (*) are required

Requestor Information:

Name:		*
Title:
Name of Organization:
Address:		*
City:		*
Province / State:		*	(Where applicable)
Postal / ZIP Code:		*
Country:		*
Website Address / URL:
Please fill in at least one of the following so that we can contact you if required: *
	Phone #:		( ) - (if within North America)
	Phone #:		(if outside North America)
	Fax #:		( ) - (if within North America)
	Fax #:		(if outside North America)
	E-Mail Address:
Have you previously received permission to reproduce the requested material?: * Yes No
If Yes, please specify the file # included in the permission letter:
Source Material Information:
Is this material from a: * Publication Website

If a Publication, please specify:
	Title:	*
	Author:
	Date of Publication:		Month Day Year
	Source Ministry:
	Total Number of Pages in Publication:
	ISBN #:
	ISSN #:
	Page #'s to be reproduced:	*
If a Website, please specify:
	Source URL:	*

Intended Use:
Number of copies to be reproduced:		*
Nature of Intended Use: (Check all that apply)
Commercial (i.e. Are you profiting from distribution of the material?) Non Commercial (i.e. Will you be giving the material away free of charge?) Educational (i.e. Are you a university; college; pre-school, elementary, secondary school; or non-profit organization created by law?)
If Commercial, please specify:
	Proposed Retail Price:	*
Please provide all relevant details, including the purpose served by the proposed work, and contact information for other persons or parties involved in the production or distribution of the proposed work:

Please Note: the majority of copyright requests will be subject to a processing fee.