Reproduce ATSSA Materials Form
Reproduce/Reprint ATSSA Trademarked/Copyrighted Material(s) Request Form
Complete this form (page 1) and email it to ATSSA at [email protected]
Date: Our company/organization requests permission from the American Traffic Safety Services Association (ATSSA) to reproduce and/or reprint ATSSA trademarked and/or copyrighted material(s) as specified below. Upon ATSSA’s written approval, our company/organization will ensure that the appropriate credit is given to ATSSA as the original source of the requested material(s). The credit citation will include the following statement on the reproduced materials: “Materials reproduced (and/or reprinted) with the permission of the American Traffic Safety Services Association (ATSSA).” Name of Requesting Company/Organization: Full Address: City:
State/Province:
Zip:
Contact Name: Email: Phone:
Alternate Phone:
Date(s)/period requested to use ATSSA material(s): Intended use/purpose of materials for this request and specific sections to be reproduced. BE SPECIFIC.
Requestor’s Signature
Printed Name
Date
American Traffic Safety Services Association 15 Riverside Parkway, Suite 100 Fredericksburg, VA 22406 Phone: 540-368-1701 [email protected] www.atssa.com
Click to Email Form
Reproduce ATSSA Materials Request Form Rev. 7/16
www.atssa.com
Page 1 of 2
Response to Reproduce/Reprint ATSSA Trademarked/Copyrighted Material(s) Request For ATSSA Office Use Only
Date: From: To: Email: Subject:
ATSSA Communications Department
Your Request to Reproduce/Reprint ATSSA Trademarked/Copyrighted Material(s)
Your request to reproduce ATSSA trademarked and/or copyrighted material(s) is: Approved
Not Approved
Note(s) associated with this request:
All approved requests must include the following statement: “Materials reproduced (and/or reprinted) with the permission of the American Traffic Safety Services Association (ATSSA).”
ATSSA Approval by:
Title:
Signature:
Date:
American Traffic Safety Services Association 15 Riverside Parkway, Suite 100 Fredericksburg, VA 22406 Phone: 540-368-1701 [email protected] www.atssa.com
Reproduce ATSSA Materials Request Form Rev. 7/16
www.atssa.com
Page 2 of 2
Complete this form (page 1) and email it to ATSSA at [email protected]
Date: Our company/organization requests permission from the American Traffic Safety Services Association (ATSSA) to reproduce and/or reprint ATSSA trademarked and/or copyrighted material(s) as specified below. Upon ATSSA’s written approval, our company/organization will ensure that the appropriate credit is given to ATSSA as the original source of the requested material(s). The credit citation will include the following statement on the reproduced materials: “Materials reproduced (and/or reprinted) with the permission of the American Traffic Safety Services Association (ATSSA).” Name of Requesting Company/Organization: Full Address: City:
State/Province:
Zip:
Contact Name: Email: Phone:
Alternate Phone:
Date(s)/period requested to use ATSSA material(s): Intended use/purpose of materials for this request and specific sections to be reproduced. BE SPECIFIC.
Requestor’s Signature
Printed Name
Date
American Traffic Safety Services Association 15 Riverside Parkway, Suite 100 Fredericksburg, VA 22406 Phone: 540-368-1701 [email protected] www.atssa.com
Click to Email Form
Reproduce ATSSA Materials Request Form Rev. 7/16
www.atssa.com
Page 1 of 2
Response to Reproduce/Reprint ATSSA Trademarked/Copyrighted Material(s) Request For ATSSA Office Use Only
Date: From: To: Email: Subject:
ATSSA Communications Department
Your Request to Reproduce/Reprint ATSSA Trademarked/Copyrighted Material(s)
Your request to reproduce ATSSA trademarked and/or copyrighted material(s) is: Approved
Not Approved
Note(s) associated with this request:
All approved requests must include the following statement: “Materials reproduced (and/or reprinted) with the permission of the American Traffic Safety Services Association (ATSSA).”
ATSSA Approval by:
Title:
Signature:
Date:
American Traffic Safety Services Association 15 Riverside Parkway, Suite 100 Fredericksburg, VA 22406 Phone: 540-368-1701 [email protected] www.atssa.com
Reproduce ATSSA Materials Request Form Rev. 7/16
www.atssa.com
Page 2 of 2
