Copyright & Content Permissions Inquiry Form | Myasthenia Gravis Foundation of America

Complete the online form below to request MGFA copyright permission for content on myasthenia.org. MGFA requires a clear understanding of how you plan to utilize or post our content. If you need to reach out to the MGFA with a question or other request, please email mgfa@myasthenia.org.

Permission Request

Name(Required)

First Last

Email Address(Required)

Organization / Affiliation(Required)

Title(Required)

Phone(Required)

Type of Permission You Are Requesting

Please select the primary category that best describes the intended use:(Required)

Clinical Trial Use

Academic Use (research, coursework, theses, presentations)

Publication Use (journals, books, scientific articles)

Commercial Use

Media or Communications Use (videos, presentations, podcasts, websites)

Internal Organizational Use

Other

Please describe the nature of your request.(Required)

Identify the MGFA Material You Wish to Use

Title or Description of the Material(Required)

If quoting a specific section, include the exact text.

Citation or Link to the MGFA Material(Required)

URL or reference information

How do you plan to post or distribute the material? (select all that apply)(Required)

Brochure

Website Page

Presentation Slide(s)

Image/Graphic

Video/Audio

Assessment Tool / Classification / Scale

Other (please specify)

Other – How do you plan to post or distribute the material?(Required)

Other – How do you plan to post or distribute the material?

Upload any files or excerpts relevant to your request (optional)

Drop files here or

Max. file size: 100 MB.

Intended Use Details

Please describe exactly how the material will be used.(Required)

Include where, when, and for what audience the content will be shared or published.

Will the material be reproduced or distributed?

Estimated distribution size or reach(Required)

Will any fees be charged for access, participation, or distribution of the work containing MGFA content?

Please explain the fees(Required)

Is this request for website use?

Please provide the URL of the website(Required)

Rights Verification

To your knowledge, does your organization hold any existing rights or agreements related to this material?(Required)

Yes

Unsure

If Yes or Unsure → Please provide details or upload documentation(Required)

Are redline changes needed for the agreement?

Terms & Conditions + Digital Signature

Legal Consent(Required)

I agree to the terms and conditions.

Consumer Disclosure Regarding Conducting Business Electronically, Signing Documents Electronically, and Receiving Electronic Notices and Disclosures

Please read the information below, carefully, as it concerns your rights. eSignatures are an efficient way to execute an agreement with the same legal force and effect of a handwritten or “wet ink” signature. By signing this document you are agreeing that you have reviewed this Consumer Disclosure and consent and intend to transact business electronically; to use electronic signatures instead of wet ink signatures and paper documents, and to receive notices and disclosures electronically.

You are not required to sign documents electronically or to receive notices and disclosures electronically. If you prefer not to transact business electronically, you may request paper copies from the “sending party” and withdraw your consent at any time, as described below.

Scope of Consent
By utilizing this Service, you agree to receive electronic signature documents with all related and identified documents, notices, and disclosures provided during your relationship with the “sending party.” You may withdraw your consent, at any time, by following the procedures outlined below.

Paper Copies
You are not required to sign documents electronically, or receive notices or disclosures electronically, and may request paper copies of documents or disclosures, if you prefer. You also have the ability to download and print any signed or unsigned documents sent to you through the electronic signature service. We may also email you a copy of all documents you sign using the electronic signature service. If you wish to receive paper copies instead of electronic documents you may close this web browser and request paper copies from the “sending party” by following the procedures outlined below. The “sending party” may apply a charge for additional expenses incurred by printing and mailing paper copies.

Withdrawal of Consent
You may withdraw your consent to receive electronic documents, notices or disclosures at any time. In order to withdraw consent you must notify the “sending party” that you wish to withdraw your consent to transact business electronically and to provide your future documents, notices, and disclosures in paper format. If at any time, after withdrawing your consent you choose to use our electronic signature system your use of this Service will, once again, evidence your consent to receive documents, notices, and disclosures, electronically. You may withdraw your consent to receive electronic notices and disclosures or execute an electronic signature by following the procedures described below.

Withdrawing your consent, requesting a paper copy, or updating your contact information
You always have the ability to download and print any documents sent to you through our electronic signature system. To withdraw your consent to conduct business electronically, sign documents electronically, and receive documents, notices, or disclosures electronically, please contact the “sending party” directly; by telephone, by email (sent to the “sending party” with any of the topics outlined below stated in the subject line of your email) or by postal mail to their mailing address specified to receive such notices.

“Withdrawal of Consent To Transact Business Electronically” To allow the “sending party” to identify and facilitate your withdrawal of consent to transact business electronically, please provide your name, email address, the date on which you are withdrawing your consent, your telephone number and mailing address.

“Requesting A Paper Copy” To allow the “sending party” to identify you to provide a paper copy of the document requiring your signature, the notice, or disclosure, please provide the sending party with your name, email address, mailing address, telephone number, and name of the document of which you are requesting a paper copy .

“Update Your Contact Information” To allow the “sending party” to identify you in order to update your contact information, please provide them with your name, email address, mailing address, and telephone number.

The “sending party” will inform you of any fees related to costs for printing and mailing paper copies or your withdrawal consent to transact business electronically.

Requestor Submission & Next Steps

Please include your name, date, and then sign the document using the “Click to Sign” box below. You can ignore the “For MGFA Use Only” section, but you must click or tap on the “Submit” button at the bottom of the page. Signing the document will not automatically submit it to MGFA staff members.

Upon submission, your request will be routed to the appropriate MGFA team for review. Typical response time is 5–10 business days depending on the nature and complexity of the request.

Requester Name(Required)

First Last

Requester Signature Date

Requester Signature(Required)

For MGFA Use Only

Do not add information below but make sure you submit before you leave this page.

MGFA Signature Name

First Last

MGFA Signature Date

MGFA Signature

Waiting for another signer

Search

Permission Request

Type of Permission You Are Requesting

Identify the MGFA Material You Wish to Use

Intended Use Details

Rights Verification

Terms & Conditions + Digital Signature

Requestor Submission & Next Steps

For MGFA Use Only