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All requests for PMI materials must be submitted through this form. Please be as detailed and complete as possible. Any vague or incomplete submissions will delay the processing of your request.

Information about the individual and/or organization submitting the request.
(Per Copyright Law, requestor must be a member or employee of the requesting organization.)
* Requestor Name:
Organization:
Title:
Address:
Address Line 2:
Address Line 3:
City:
State/Province:
Zip/Postal Code:
Country:
Home Phone:
Work Phone:
Fax Number:
* Email Address:
PMI Membership Number (if any):
PMI R.E.P. Number (if any):
Type of Organization:
Information about the requested material(s)
Please identify the exact PMI copyrighted material(s) you wish to use.
(If you are requesting multiple publications, please provide detailed citation information under Other Useful Comments at the end of this form.)
Name of PMI Publication:
Name of author/editor:
Edition or periodical volume/issue/date:
Name of article:
Page Numbers:
Figure Numbers:
Estimated percentage of all requested PMI material(s) you intend to use in your work.
Estimated Percentage (%):
The specific intended use of the requested PMI material(s), including length of time for requested permitted use
Specific Intended Use:
Detailed information concerning the manner in which the PMI copyrighted material will be used, including, but not limited to: (a) the type of publication, (b) publication format, (c) title, (d) names of all authors or editors, (e) publication date, (f) name of publisher, (g) projected list price, price charged per copy, or price for class in which the publication will be used, (h) total number of pages in the final, complete publication and (i) percentage of the final, complete publication which consists of PMI copyrighted material.
(a) Type of Publication:
(b) Publication Format:
(c) Title:
(d) Names of all Authors/Editors:
(e) Publication Date:
(f) Name of Publisher:
(g) Price:
(h) Total Number of Pages:
(i) Percentage (%):
Total number of copies to be produced. Include your calculations.
(print run, number of editions, class capacity, number of times the class will be held, etc.)
Copies:
Identify the countries in which the work will be published or otherwise be used
Countries:
Explain in detail the nature of the work Please note: The work/the excerpts of the work that involve PMI requested materials, regardless of format, must be inspected before permission is granted. When available in its complete but unpublished form, please send a copy to the address/email address at the end of this form.
Nature of Work:
For consultants wishing to use materials in a presentation format, identify (a) the organization(s) for which the presentation will be given (b) the number of times the presentation will be given, (c) the estimated total number of participants, (d) any fees charged to the organizations/participants, (e) any special details about the presentation or audience
If your work is non-profit, note that here.
(a) Organization(s):
(b) Number of Times:
(c) Number of Individuals:
(d) Fees:
(e) Details:
If you are requesting electronic or digital rights, explain specifically your intended use: What specific rights are being requested? In what form? How will the materials be used? For intranet requests, include the number of people who have access to the intranet and the level of security for the intranet.
Explanation:
If any pertinent permission was previously granted by PMI pertaining to the requested materials and/or requested use which is the subject of this request, fax copies of the past agreement(s) to the number at the end of this form.
Other Useful Comments:
A submission of the above information is not an implied permitted grant of use of the requested materials. Any use, if granted, will be sent separately to the Requestor and executed by the Rightsholder.
Thank you for your cooperation.


* Required Field(s)	041220071505