Permission to Use Material from the Institute for Integrative Nutrition®

Over the past 20 years, the Institute for Integrative Nutrition® has created and compiled materials that we use to effectively spread our mission of improving health and happiness through our unique and innovative life-changing Health Coach Training Program. These materials include, but are not limited to, our curriculum, newsletters, recipes, and images like our Integrative Nutrition® Plate and the Integrative Nutrition® Circle of Life, and they are protected by copyright.

If you would like to request permission to use any of our copyrighted material, or have questions about which materials are subject to copyright, please complete the form below so that may fully understand your request and the context in which you intend to use our copyrighted material. In order to facilitate our review of your request, please complete all of the fields below. Partial submissions will not be considered.

First Name *

Last Name *

Email *

Street Address *

Phone Number *

Address Line 2

City *

State

Country *

Zip Code

Are you currently a *

Student

Alum

Ambassador

Year of (Expected) Graduation (YYYY) *

Which of the following describes your intended use? *

online website

online blog

printed promotional materials (i.e. business cards, flyers, mailers)

hard copy publication (i.e. book, magazine)

newsletter or mass email

other, please describe: other, please describe:

If your use of material from Integrative Nutrition® will be online, please include the website address(es) here and the specific URL at which the material will be incorporated:

Title of publication (e.g. name of book or blog) *

If applicable, name of the publisher for printed materials

Description of purpose of publication (e.g. magazine devoted to creating evolution in the field of permaculture) *

Provide additional information regarding your intended manner of use (e.g. incorporation into my magazine titled [insert title] devoted to [insert subject matter]; distribute to friends as a flyer with other material that I have created for the purpose of [insert purpose of distribution] and under the title [insert title of flyer])

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Do you intend to circulate, distribute, or sell the publication or product? *

yes

no

Please describe the targeted audience or consumer base for publication/distribution (e.g. sustainability educators and activists in my hometown of Madison, Wisconsin) *

Approximate size of the target consumer base *

Channels of distribution (e.g. Union Square farmers market in NYC, my health coach office in Erie, Pennsylvania) *

If applicable, please describe advertising and promotional tools (e.g. Facebook, personal website, online webinar, radio interview)

Please submit a copy of the exact material(s) you are requesting to use. *

Please submit a final sample of what you intend to produce/publish which shows how material from Integrative Nutrition® will appear in that final publication/product.
*

Will you provide or offer the publication, product or website that incorporates material from Integrative Nutrition® for a fee or in connection with services you produce for a fee? *

yes

no

What is the fee (please enter as U.S. currency) *

Who will earn the revenue generated from sales? *

If you intend to receive revenue in connection with the sale of goods that will incorporate material from Integrative Nutrition® please attach a budget including the fee/cost to consumers (or internet users) and any related expenses associated with the project to indicate your expected profit.

Please provide any additional information you would like us to consider in connection with your request

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I hereby agree to the following criteria should I be granted permission to use the material(s) requested in this form:

1) I will not edit any portion of the copyrighted material(s).

2) I will give credit to the Institute for Integrative Nutrition® as the source of the material(s).

3) If my use of material(s) is online, I will include a link to: http://www.integrativenutrition.com.

4) I will not use the requested material(s) under circumstances not specified in this request and approved by Integrative Nutrition®. I understand that deviations from my inital request require the submission of another Permission to Use request. *

I have read and agree to these terms