Application for Use of GOLD Materials

Applications for use of GOLD materials, including translations, scientific publications, and educational materials for doctors and students, should be submitted through the Web-based form below.

Requests for use of GOLD materials for educational, non-commercial purposes will generally be approved on condition that modifications will not be made in the text and that appropriate acknowledgement will be made to the source materials.

Requests for use of GOLD materials for commercial purposes will be evaluated on a case-by-case basis and generally a fee will apply for any commercial use of these materials.  Applications for use of GOLD materials that have a commercial connection will be referred for review to US Health Network, Inc. (USHN), a medical communications firm that works with GOLD on communications and the commercial use of GOLD materials.  In cases of requests for commercial use, USHN will determine the fee that will apply.  After deduction of applicable costs to USHN, fees from commercial use of GOLD materials are used to assist in the funding of GOLD activities.

The form below will assist in the process of evaluating requests to reproduce GOLD materials in whole or in part, including figures, tables, and logos. This process is not intended to restrict or restrain the work performed by individuals and organizations to disseminate and implement best practice for COPD patients.  Instead, this process should be viewed as a necessary activity to ensure that GOLD materials are used freely for educational purposes but that GOLD has the opportunity to benefit from the profits of commercial use of these materials.

All fields in the form below are mandatory. Please fill in all blanks before submitting the form.

Applicant Name:
Applicant Address:
Email Address:
Organization Represented: (if any)
1. Is commercial support involved directly or indirectly in the proposed use? (Yes/No)
2. Indicate the GOLD document and pages, tables, or figures that you wish to reproduce:
3. Indicate the proposed use of materials, including the form(s) in which it will be disseminated, the number of copies that will be distributed, and whether or not a commercial organization will be using the material:
4. Will a commercial organization (for example a Pharmaceutical or Publishing Company or a Commercial Agency) provide funds for the dissemination, or if funds for the dissemination come from a professional group, will this professional group receive commercial funds for the activity?
5. If used for commercial purposes, will you provide a copy to GOLD prior to its release?
6. Will the GOLD material be submitted for publication in a medical journal? If yes, please indicate the name of the journal.
7. Will there be any charge made for the disseminated document that includes the GOLD material?
Name
Date