Please provide the legal name of the institution, company, or other entity that will appear on the contract
Please list the organization's primary address including CITY, STATE, ZIP CODE
Who should be contacted for follow ups?
The AMA will transmit the requested electronic file (the “File”) in PDF form via your institution’s EFT or FTP site. If your institution does not have an EFT or FTP site, place “N/A” on the line above.
By submitting this request, I certify that the request is on behalf of a student of Requestor with a documented print disability who has purchased, or on whose behalf Requestor has purchased, a copy of the above requested book for use in a course in which the student is registered and the File will be provided to that student only for their academic purposes. Please allow 2-3 weeks for processing. The AMA reserves the right to deny or request additional supporting information for a request for permission to use AMA content.
By submitting this request, I certify that this request is on behalf of an employee of Requestor with a documented print disability who has purchased, or on whose behalf Requestor has purchased, a copy of the above requested book during the course of his/her employment and the File will be provided to that employee only for their employment purposes.
Check box to confirm that you are attaching an electronic copy of the receipt.
This is a required field. Please enter any additional comments or details that are necessary to complete this request.