ACR Permission Request Form

The American College of Radiology (ACR) handles all requests to reproduce material from the ACR. For your convenience, the form for applying for publications permissions is provided below. Note, if you are requesting permission to use images, please fill out form accordingly.

All materials requested must be used verbatim with proper citation. Please include the full reference of the material you wish to use (journal or book name, year of publication, volume and issue numbers, author, file of article, figure numbers where appropriate, etc.). We also require a detailed overview of how you intend to use the material (i.e., in a book).

Name*

First NameLast Name

Job Title

Organization*

Organization Type

CommercialNon-profit

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

E-mail*

ACR Section (Select all that apply)*

What information do you wish to reprint/reference?

ACR Publication Title or Content*

Publication Date

Version/Volume*

ACR Content to be used*

Please include 1) Publication Title, 2) Publication Date, and 3) Version/Volume if applicable.

URL (your publication)

Authors/Editors:

Your Publication/Project Title *

Details of content usage in your publication*

Distribution Method

PrintWebsiteeNewslettereBook

URL

Use Category*

Book/journalEducationPowerpointBrochure

Will the publication be: *

Sold for profitDistributed for free

Language*

Attachments

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ACR STAFF ONLY

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Comments/ additional information

This field is required for all ACR stafff.