Southeastern Surgical Congress

COPYRIGHT RELEASE

 Title of Article                    

                                                                                                                            

                                                                                                                             

                                                                                                                             

"In consideration of the review, consideration, editing, and publication of the above entitled article in THE AMERICAN SURGEON, the author(s) hereby undersigned transfer(s), assign(s), or otherwise convey(s) all rights in and to said article, including all copyright rights therein, to the Southeastern Surgical Congress."

"The author(s) warrants that the article and all illustrations used therein are original, have not been previously published or submitted for publication, and are non-infringing and non-libelous."

 Author(s) Signatures

__________________________________
Type name and sign

__________________________________
Type name and sign

__________________________________
Type name and sign

__________________________________
Type name and sign

__________________________________
Type name and sign

__________________________________
Type name and sign

__________________________________
Type name and sign

__________________________________
Type name and sign


Name, address, e-mail address, telephone number, and FAX number of corresponding author:
__________________________________

__________________________________

__________________________________

__________________________________
E-mail Address
__________________________________
Telephone Number
__________________________________
FAX Number

      Mail this form to: J. David Richardson, M.D.
      Department of Surgery
      University of Louisville
      550 South Jackson Street, 2nd Floor ACB
      Louisville, KY 40202

 

Back to Forms Page

We appreciate your visit. Please contact us with any questions or comments you might have or visit our FAQ page.