Conbook Submission Release Form

PLEASE PRINT CLEARLY. Fill out all fields below in full, or we will be unable to use your work. If you e mail your release or send a written release separate from this document, be sure to include all information on this form. All material must be received no later than April 30, 2008.

Section 1: Contact Information

Real Name:

________________________________________________________________________________

Mailing Address:

________________________________________________________________________________

________________________________________________________________________________

Phone Number:

________________________________________________________________________________

E-mail Address:

________________________________________________________________________________

Privacy Statement: The information provided here is for use by Anthrocon solely to provide more efficient service to its members. No information will be sold or traded to any third party for commercial purposes.

Section 2: Submission Information

List all submissions being released for use by title of the submission or filename, and whether they may be used in other Anthrocon publications. Continue on reverse if necessary.

Piece Title or Filename: May we use for other publications? (Yes/No)

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

________________________________________________________________________________

Name to display with submission(s): ____________________________________________
(if different from real name)

Section 3: Release Information

I, ____________________________________ (print your full, real name), agree to the terms and conditions as stated in the Anthrocon 2008 Conbook Submission Guidelines and hereby grant Anthrocon non-exclusive rights to publish the above submissions according to those guidelines.

________________________________________________________________________________
Signature

____________________________
Date

We cannot use any work without a signed release form on file. Please mail this completed form to:

Anthrocon - Publications Dept.
c/o Karl Jorgensen
P. O. Box 4211
Leesburg, VA 20177

This address is for conbook-related correspondence only. If you have any questions, please contact us at book-2008@anthrocon.org, or visit our website at http://www.anthrocon.org/

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