Request permission to reproduce clinical images

All content on the AHMF website, including clinical images, is copyright. Persons or organisations wishing to reproduce images from the AHMF website require written approval. If you wish to reproduce an image, please complete this form. The AHMF will respond with instructions on reproducing, attributing and (in certain instances) paying for the image.

What images do you intend to reproduce?

Please select the image(s) you would like to reproduce.

Image(s): *

Select the images you wish to reproduce

How will you use the images?

Please select all relevant answers.

Other:

Where will the image(s) be reproduced?

Title of book/journal/CD/website/educational resource:

Date of publication:

Publisher/organisation/institution:

Who is the intended publisher/distributor of the publication containing the image(s)

Web URL/address:

For web publications, please give the address of the page on the website where the image is intended to appear.

Individual reprints:

Please describe details

Other information:

Please provide any further information you feel is relevant

Your details

Your name: *

Organisation/institution:

Address:

Is your organisation a non-profit entity?:

yes

Telephone number:

Please include country and area code

Email address: *

Your reference:

Australasian Sexual Health Conference 2010

Monday, 18 October 2010 (All day) - Wednesday, 20 October 2010 (All day)

Australian Herpes Management Forum, c/- STIRC, Marian Villa, Westmead Hospital, Westmead NSW 2145, Australia.

Telephone: +61 (2) 8230 3843 - Fax: +61 (2) 9845 6287

Contact AHMF by email - ACN 096 346 477 - ABN 85 096 346 477

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