The Joint Commission Website Permissions/Reprints Request Form
Please complete this form and e-mail it to Terri Argumosa at targumosa@jointcommission.org
Date of Submission:
Organization name:
Joint Commission Accredited and
or Certified Organization?
□ Yes □ No
Contact name:
Address:
Phone :
E-mail Address:
Page Title(s) of Requested Material:
URL(s) (website address) of Requested Material:
How will the material be used? (E.g. book, newsletter, magazine, website, presentation materials, staff
education material):
Will you be selling or making a profit from the material (e.g. selling a book, receiving an honorarium for a
presentation)?
□
Yes
□ No
If applicable, number of copies being made of material:
For more information, contact Terri Argumosa, targumosa@jointcommission.org, 630-792-5631.
For Internal use only