AGREEMENT

____________________________________________________________________ (authorized individual name and title) on behalf of the guideline author/developer/owner(s),
_____________________________________________________________________________, hereby grant to AHRQ, and its agent(s), exclusively for NGC purposes, the following non-exclusive worldwide rights and licenses:

1.	To copy and abstract __________________________________________________'s (our organization's) clinical practice guidelines ("guidelines"), including the guideline's recommendations and detailed information about the guideline's development, and to place such abstract(s) on the NGC World Wide Web site.

Yes		No 	(circle one)

Permission* is given for (circle all that apply):
a.	Guideline(s) titled _______________________________________________________ and dated ______ (attach additional sheets, as necessary, or refer to the NGC-specific attachment)
b.	All future published revisions/updates of the guideline(s) specified in (1a).
c.	All guidelines by our organization published to date
d.	All new guidelines to be published in the future (i.e., all guidelines from our organization that meet NGC inclusion criteria)

2.	To place the full-text guidelines on the NGC World Wide Web site.

Yes	No	(circle one)

3.	To establish links from the NGC World Wide Web Site to your organization’s Web site: http://__________________________________________.

Yes	No	(circle one)

AHRQ and its agent(s) (ECRI) agree to provide full credit to your organization as the author/developer/owner(s) of such clinical practice guidelines and to inform NGC users about the terms governing downloading, use, and reproduction of these guidelines as set forth below or to refer them to your organization for such information as directed below:

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

You agree to provide to ECRI a computer-readable full-text version (if available) of your organization’s clinical practice guidelines that have been accepted for inclusion in the NGC and that will be referenced or posted at the NGC Web Site.

You represent and warrant that you are the author of the guidelines and owner of your Web Site, or currently possess all rights necessary to grant the rights granted herein.  You represent and warrant that your guidelines do not infringe any copyright, trademark or other proprietary right of any third party.

I/we, the signators of this license represent and warrant that I am/we are the author(s) of the guidelines and/or possess all rights necessary to grant the license rights above to AHRQ and its agents.  I/we represent and warrant that the guidelines so licensed do not infringe any copyright, trademark or other proprietary right of any third party.
This agreement shall be effective as of the later date signed below and shall remain in force unless terminated by either party by giving prior written notice of not less than six months.

Name(s) of Guideline Developer(s) (please print)

_______________________________________________________________________

Name(s) of individual(s) authorized to grant rights to use guideline(s) referenced above:

_______________________________________________________________________

Signature(s) of authorized individual(s): _______________________________________

________________________________ (title) _____________________ Date: _______

________________________________ (title) _____________________ Date: _______

Organization:____________________________________________________________

Address:________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

Telephone: ______________ Fax number: _______________ Email: _______________


ECRI will send a copy of this document to the NGC Project Officer at AHRQ.