Novo Nordisk Inc. Copyright Permission Request Form

Novo Nordisk Inc. Copyright Permission Request Form

Please complete this form to request permission to use Novo Nordisk Inc. copyrighted materials.
Most requests are reviewed within two weeks. Please contact GLIA@novonordisk.com or Cindy at 609-987-5297 for assistance.

First Name *

Please fill in first name

Last Name *

Please fill in last name

Organization *

Please provide organization

Mailing Address *

Please provide mailing address

Fax Number *

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Phone Number *

Please provide phone number

E-Mail Address *

E-mail address is required Please use a valid e-mail address

Detailed description of the material you wish to use (include ID number if available) *

Please provide description

Do you already possess a copy of the item/material you wish to use? *

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Detailed description of how the material will be used, including format and purpose *

Please provide purpose

Please attach any relevant files *

You can attach multiple files by pressing ‘ctrl’ and then clicking on each file which you would like to attach. The total maximum size must not exceed 10 MB. For security reasons only the following file formats are allowed: Word, Excel, PDF, Power Point and Email
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