PERMISSION REQUEST FORM TO REPRODUCE UNSCEAR MATERIAL
Please note, that for each UNSCEAR publication a separate request form is required, however, up to
six items (e.g. figures, tables) can be requested using the same form (see example on next page).
Please email the completed request form to [email protected] as attachment (MSWord not scan).
I (we) request permission to reproduce the UNSCEAR material listed below for the
purpose specified in this form. I (we) would also seek ongoing, non-exclusive, worldwide
electronic and print rights for all subsequent editions in foreign language translations for
distribution throughout the world. Unless you indicate otherwise, I (we) will use the complete
reference given below as the credit line. If you do not control the rights, kindly direct to whom
the permission request should be addressed.
Contact details of the requestor(s):
Please provide the relevant contact details of requestor(s) by writing directly in the dedicated fields.
Title. surname, first name
Phone number with country code
Email
Date of submission (dd/mm/yyyy)
Institution
Address – Street name and nr.
Address – City (ZIP)
Address – Country
Purpose of the permission request:
Please provide the specific purpose for the requested permission by using the dropdown list and by
writing directly in the dedicated fields.
Select purpose for requested permission
Title of paper/chapter/book or presentation
Publisher of paper/chapter/book or congress name (including place, date) in case of presentation
Description of material to be used:
Please provide exact information of the UNSCEAR material to be used (including pages) by using the
dropdown list (e.g. figures, tables) and by writing the title(s) directly in the dedicated fields.
Title of UNSCEAR Report
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information
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information
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information
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information
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information
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information
Annex A, B, C, …
Title of figure/table/chapter
Title of figure/table/chapter
Title of figure/table/chapter
Title of figure/table/chapter
Title of figure/table/chapter
Title of figure/table/chapter
Please don’t complete this section as is for the use by the UNSCEAR secretariat.
Permission is granted to reproduce the UNSCEAR material for the work as set out above.
The acknowledgement should include “Reproduced by permission of UNSCEAR”.
Name:
_________________________
Signature: _________________
Function:______________________
Date: ______________
N°: ______________
UNSCEAR secretariat, P.O. Box 500, A-1400 Vienna, Austria
AN EXAMPLE OF A COMPLETED UNSCEAR PERMISSION REQUEST FORM
I (we) request permission to reproduce the UNSCEAR material listed below for the
purpose specified in this form. I (we) would also seek ongoing, non-exclusive, worldwide
electronic and print rights for all subsequent editions in foreign language translations for
distribution throughout the world. Unless you indicate otherwise, I (we) will use the complete
reference given below as the credit line. If you do not control the rights, kindly direct to whom
the permission request should be addressed.
Contact details of the requestor(s):
Please provide the relevant contact details of requestor(s) by writing directly in the dedicated fields.
Dr. Mayer, Peter
Radiation Research Institute
+49 1 2345 6789
[email protected]
Hauptstr. 5
29/12/2015
Germany
Munich (81299)
Purpose of the permission request:
Please provide the specific purpose for the requested permission using the dropdown list and by
writing directly in the dedicated fields.
Presentation
Radiation exposure of the public
IRPA 14 (Cape Town, 12 May 2016)
Description of material to be used:
Please provide exact information of the UNSCEAR material to be used (including pages) by using the
dropdown list (e.g. figures, tables) and by writing the title(s) directly in the dedicated fields.
UNSCEAR 2008 Report
Annex B
Table 6, pages 329-331
Absorbed dose rates in air (nGy/h)
Table 8, page 335
Reference annual intake of air, food and water
Figure V, page 381
Reported concentrations of 238U in soil
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information
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information
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information
Title of figure/table/chapter
Title of figure/table/chapter
Title of figure/table/chapter
UNSCEAR secretariat, P.O. Box 500, A-1400 Vienna, Austria