Manuscript Number*:


Publication Title:

Manuscript Authors:

Corresponding Author Name and Address:

The author(s) warrant(s) that the above cited manuscript is the original work of the author(s) and has never been published in its present form.

The undersigned, with the consent of all authors, hereby transfers, to the extent that there is copyright to be transferred, the exclusive copyright interest in the above-cited manuscript (subsequently called the “work”), in this and all subsequent editions of this work, and in derivatives, translations,  in English and in foreign translations, in all formats and media of expression now known or later developed, including electronic, to the GMJ Publisher

The undersigned author and all co-authors retain the right to revise, adapt, prepare derivative works, present orally, or distribute the work provided that all such use is for the personal non-commercial benefit of the author(s) and is consistent with any prior contractual agreement between the undersigned and/or coauthors and their employer(s).

In all instances where the work is prepared as a “work made for hire” for an employer, the employer(s) of the author(s) retain(s) the right to revise, adapt, prepare derivative works, publish, reprint, reproduce, and distribute the work provided that such use is for the promotion of its business  enterprise and does not imply the endorsement of GMJ.

SIGN HERE FOR COPYRIGHT TRANSFER [Individual Author or Employer’s Authorized Agent (work made for hire)]

Print Author’s Name: Signature of Author (in ink):

Print Agent’s Name and Title: Signature of Agency Rep (in ink):



If the manuscript is not accepted by GMJ or is withdrawn prior to acceptance by GMJ, this transfer will be null and void and the form will be returned to the author.

*Electronic /postal/ submission of the manuscript for the review acknowledges of copyright agreement acceptance and additionally requires sending the signed and scanned form to the publisher. This agreement is governed by Polish Law