Your paper has been received and if accepted will be published in Journal of Korean Gerontological Nursing. Please read the notes overleaf. Then complete parts 1 and 2 of this form, sign and return this form to the Editorial Office at the address below. If you do not own the copyright to your article, please complete part 1 and get the copyright holder to complete and sign part 3.

1. Name: ________________________________________________________________________________
Address: ______________________________________________________________________________
Article title: _____________________________________________________________________________

2. To be filled in if copyright belongs to you
In consideration of the publication of my contribution in the above journal, I hereby warrant:

(a) that in the case of joint authorship I have been authorized by all coauthors to sign this agreement on their behalf and that I have printed the full names of all co-authors in block letters below;

(b) that this article is the author(s)’ original work, has not been previously published elsewhere either in printed or electronic form (including World Wide Web home pages, discussion groups and other electronic bulletin boards), and is not under consideration for publication elsewhere;

(c) that this article contains no violation of any existing copyright or other third party right or any material of an obscene, libelous or otherwise unlawful nature, and that I will indemnify and keep indemnified the Editors and Korean Gerontological Nursing Society all claims and expenses (including legal costs and expenses) arising from any breach of this warranty and the other warranties on my behalf in this agreement;

(d) that I have obtained permission for and acknowledged the source of any illustrations, diagrams or other material included in the article of which I am not the copyright owner.

In consideration of the publication of my contribution in the above journal, I hereby assign to Korean Gerontological Nursing Society the present and/or future copyright, including the right to communicate this article throughout the world in any form and in any language (including without limitation on optical disk, transmission over the internet and other communications networks, and in any other electronic form).

Printed name _________________________________   Signature _________________________________
Date ________________________________________
(to be signed by corresponding or senior author on behalf of all authors)

List of all co‐authors on whose behalf the author is signing:
Printed name _________________________________   Signature _________________________________
Printed name _________________________________   Signature _________________________________
Printed name _________________________________   Signature _________________________________
Printed name _________________________________   Signature _________________________________
Printed name _________________________________   Signature _________________________________

3.To be filled in if copyright do not belong to you. Please provide the complete and full title of the copyright holder. It is the author’s responsibility to provide the correct information.
Name and address of copyright holder (if not the author) ____________________________________________ _________________________________________________________________________________________
In consideration of the publication of the above article in the above journal, I hereby grant non‐exclusive rights to Korean Gerontological Nursing Society to publish the article throughout the world in any form and in any language (including without limitation on optical disk, transmission over the internet and other communications networks, and in any other electronic form) and non‐exclusive rights to deal with requests from third parties.
______________________________ (Signature of copyright holder)   Date _________________________

PLEASE RETURN ONE SIGNED COPY OF THIS FORM TO THE EDITORIAL OFFICE
Dukyoo Jung, PhD, RN.
Editorial office of the JKGN
College of Nursing, 52, Ewhayeodae-gil, Seodaemun-gu,
Seoul, 03760 Republic of Korea.
E-mail: dyjung@ewha.ac.kr
Tel: +82-2-3277-6693
Fax: +82-2-3277-2850

FOR OFFICE USE ONLY: Year of publication ______________________   BSA Number _________________
Volume/Issue _______________________________________________