Conbook Submission Release Form

Section 1: Contact Information
Section 2: Submission Information
Section 3: Release Information

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.

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. Unless requested otherwise, submitted artwork may be used for other Anthrocon publications (i.e., keycards, programming materials, etc.)

Piece Title or Filename: ________________________________________
________________________________________
________________________________________
Name to display with submission(s):
(if different from real name)
________________________________________
[ ] Check here if you do not want your submission used in other Anthrocon publications.

Section 3: Release Information

I, ____________________________________ (print your real name), agree to the terms and conditions as stated in the Anthrocon 2010 Conbook Submission Instructions 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. E-mail this form to book-2010 AT anthrocon.org, or mail to: Anthrocon / Publications Dept., P. O. Box 4211, Leesburg, VA 20177. This address is for publications-related correspondence only.

All material must be received no later than April 26, 2010.
0
No votes yet
Your rating: None