Publication Request Form

Service Fee
There is a $25 USD service fee associated with these requests. Payment is not a guarantee of approval, and is intended to compensate for employee time needed to review requests. Requests will not be reviewed until payment is made. There is a link to follow at the end of the questionnaire.

Information about your request
Which wheel(s) are you seeking permission to use?*
- Power and Control (original)
- Equality Wheel
- Post-Separation Power and Control Wheel
- Abuse of Children Wheel
- Nurturing Children Wheel
- Culture Wheel
- Creator Wheel
- Christian Power and Control
- Christian Partnership
Title of the Publication, Curriculum, Article, or Thesis*
Name of Publishing Company
Publishing company's website
Publishing company's address
Abstract*
Please provide a short abstract or description describing the overall theme, intent, and purpose of the publication / curriculum / article / thesis. How are you going to use the wheel?
Intent and purpose*
Please provide a brief description of the reasons you would like to include the wheel in your publication.

Uploads
Image of the Wheel*
Please provide a copy of the exact image(s) you would like to use in your publication.
Drop files here or

Max. file size: 25 MB.
Copy of chapter or section in publication*
Please provide a copy of the chapter(s) of the publication that will include the wheel with an indication of where you will place the wheel. If submitting for an article or thesis, please provide the section(s) that will include and discuss the wheel. **We encourage you to utilize a watermark labelled "draft" or "confidential" on your pages for your copyright protections.
Drop files here or

Max. file size: 25 MB.

Payment
Service Fee*
Price:
Credit Card*
Card Details
Cardholder Name
Billing Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
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Service Fee