Rights and Translation Request

TEACH Services, Inc. Publishing

11 Quartermaster Circle • Fort Oglethorpe, GA 30742

(800) 367-1844 • Rights@TEACHServices.com

This form is a request for permission to reprint, translate, or record for replay an article, chart, book (segment or excerpt), or photo hereafter referred to as "work". All requests are subject to the Publisher's approval. Please note that permission will only be granted if all copy from the original work, including headlines and body text, appears or is recorded exactly as it was in its original form from TEACH Servics, Inc. No editorial alterations or changes are allowed. A separate request form must be made for each work you wish to use. For any questions, please contact us at the number or email above.

Book Title: *

Author: *

I wish to reprint: *

In whole In part (list portions below, as well as number of reprints to be printed) Only Photo(s), Chart(s), or Illustration(s) (list which ones below)

List portions, photos, charts, and/or illustrations you wish to reprint:

How many reprints do you wish to print: *

I wish to produce a(n): *

Printed Book Audiobook (sellable edition--ie, Audible.com) Audio (free edition--ie, YouTube.com, CD or DVD, Podcast) Radio Television PDF (not normally available) Post on a website (not normally available) e-Book (not normally available)

Give details of expected listening or viewing audience size and any other details.

(ie, 25,000 listening audience and aired three times a year)

(Audio/TV/Radio) Where will it be broadcast or uploaded?

(TV/Radio) How many times do you plan to air it?

Ex: four times a year

If posting on a website, please provide the link:

If unknown, explain why

Do you wish to reprint in another language? *

Yes (indicate language(s) below) No

Indicate language(s) you wish to reprint in:

List all languages desired

Are you requesting exclusive rights to a country or language?

Ex: Spanish edition limited to sales in Mexico

How long do you wish to retain exclusivity while you work on this project? (Indicate in months or years):

Months or Years

Requestor's Information

Full Name: *

First Name Last Name

Company Name: *

Your Position/Job Title: *

Email: *

example@example.com

Phone Number: *

Area Code Phone Number

Address: *

Please submit your completed request.

RIGHTS AND TRANSLATION REQUEST