Submit a request – American Medical Association

Please select your request type. Once submitted, a ticket confirmation screen will provide a summary of the information you've provided (All AMA employees must be logged in to submit requests)

Your email address

Subject(optional)

Organization Name

Please provide the legal name of the institution, company, or other entity that will appear on the contract

Organization Address

Please list the organization's primary address including CITY, STATE, ZIP CODE

Primary Contact Name

Who should be contacted for follow ups?

Primary Contact Email

Primary Contact Phone Number

Organization Affiliation

Please list any specialty societies or industry associations that your organization is member to or affiliated with

Description of the AMA content that you wish to use.

In a few sentences, please provide a description of the AMA content you wish to use

What kind of material is the original source of AMA content?

Was this a printed publication, online publication, web site link, etc

Type of Content

What is the other source of content? Please provide as much detail as possible

Title

Please provide the name of the requested content ("CPT Professional 2021")

Author

Please provide the author name of the requested content (eg. Rondinelli, R.)

Edition and/or volume of book or article

Please provide the book edition or the journal volume of the requested content

Copyright date

Please provide the copyright year of the requested content

URL Address

Please provide the URL to the requested content (eg. https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/principles-of-medical-ethics.pdf) or use 'n/a' to indicate that this content will not be available online

Please provide the specific chapter name(s), article title(s), page number(s), image(s), table(s) or other AMA Content proposed to be used

Please provide the specific quotation(s), chapter name(s), article title(s), page number(s), image(s), table(s) or other AMA Content proposed to be used

Quantity/volume of AMA Content to be used

Please explain the quantity/volume of AMA Content to be used (entirety of AMA Content? A portion?)

Description of proposed usage

Please describe your upcoming publication or work.

What is the format of the work?

Please choose any applicable standard formats. If other, please describe below

If other format, specify type

Please describe the proposed usage type or use 'n/a' if described above

If web-based, will access to the work be password protected?

If web-based, number of people who will have access to the work.

Use '0' if not web-based

How long will the Work be accessible?

If not for a limited period of time, indicate 'unlimited'

If web-based, describe any other restrictions on access.

If none, please type "none"

Please provide your publication details

Please provide all that apply: Author, Title, Chapter or Article title, Edition/Volume, Copyright Month and Year, Publisher, URL

Proposed context

How will the AMA material be published? In what context will it appear?

Proposed duration for use of AMA content

The maximum length of use is 3 years

Geographic territory of the proposed use

Where do you intend your content to be accessible?

Intended Audience

Please describe the main intended audience for your work

Indicated use

Please select the primary use of your proposed content

Will the Work be sold or licensed or otherwise be used to generate any fee or revenue?

What is the price and number of units that are expected to be sold, licensed and/or distributed?

Complete AMA Content/publication distributed?

Are students required to purchase AMA Content/publication?

Are students charged for class?

Price charged for class

Please provide the cost to the student for the class or 'n/a' if none

Are students charged for classroom materials?

Price for classroom materials(optional)

Please provide the cost to the student for the class materials; enter zero if none

Will you be the signer of the agreement?

This is the person authorized to execute contracts on behalf of your organization

Signer of contract(optional)

Who will be signing relevant contract for your organization

What is the contract signer's email?(optional)

This will be used to send the agreement

Check to confirm that by submitting this Application, Requestor confirms that the information provided is accurate to the best of their knowledge.

Note: Permission cannot be granted for usage of material that is not copyrighted by the American Medical Association. Requests for permission are granted at the AMA’s sole discretion. No permission is granted unless and until you receive a written permission letter from the AMA.

Comments or Questions

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