Family Medicine Copyright Release Form
Before
we can publish your manuscript, ALL AUTHORS must sign the copyright transfer statement.
If it is more convenient, this page can be copied, and each author can sign a
separate copy of the form.
Please return the form(s) directly to:
Jan
Cartwright, Publications Assistant
Family Medicine
Society of
Teachers of Family Medicine
11400 Tomahawk Creek Parkway, Ste 540
Leawood,
KS 66211
800-274-2237, ext. 5408
TITLE OF ARTICLE:
"I (we) certify
that the above-titled manuscript represents original work and that I (we) have
reviewed the final version and approve it for dissemination and/or publication.
Neither this manuscript nor a manuscript with substantially similar content under
my (our) authorship has been published or is currently being considered for publication
by any other journal.
I (we) understand that if this document, or a revised
version of this document, and any derivative forms of this document, including
electronic versions, are accepted for publication by Family Medicine, the
article will be copyrighted and become the exclusive property of the Society of
Teachers of Family Medicine. I (we) further understand that I (we) am (are) solely
responsible for the content of the published article, including changes made during
copy editing. I (we) warrant that I (we) have full power to grant the rights to
this document. In addition, I (we) grant to Family Medicine the right to
edit and revise the foregoing work.
I (we) certify that all individuals
listed as authors of this manuscript have participated in conceptualizing the
research or content of the manuscript, in writing or critically editing the manuscript,
and/or in analysis of data presented in the manuscript. I (we) certify that I
(we) have no financial affiliation/interest (eg, employment, stock holdings, consultantships,
honoraria) in the subject matter, materials, or products mentioned in this manuscript,
except as stipulated in the cover letter of the manuscript."
Name_____________________
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Name_____________________
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Name_____________________
Signature_____________________ Date_____________
Name_____________________
Signature_____________________ Date_____________
Name_____________________
Signature_____________________ Date_____________
Name_____________________
Signature_____________________ Date_____________
