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RELEASE
FORM
(Print
this form)
I, whose signature
appears below, authorize the use of my donated/copied work and/or photographs
concerning
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
for possible inclusion
in the upcoming non-fiction work, "More Sand in Their Shoes,"
with the understanding that my permission need [ ] / need not [ ]
be secured prior to publication of any part of their contents. (If neither
box is checked, the default is that the permission need not be
secured.)
Submitted by _________________________________________________
Dated ______________________
Submission Credit
name as he/she wishes it to be used:
____________________________________________________________
Contact phone number:
_______________________ _________________
Email address: ________________________________________________
Disclaimer:
Sandy Thorpe and/or Martin W. Taplin reserve the right to edit, at their
sole discretion, the above submitted work for inclusion in their upcoming
non-fiction work titled, "More Sand in Their Shoes" and any
other future literary work.
Please email (sthorpe@taplin.com),
fax (305-864-5744) or mail this form with materials submitted to:
Sand in
Their Shoes
c/o Taplin
1177 Kane Concourse, Suite 201
Bay Harbor, FL 33154
If you have any questions, please call Sandy Thorpe at 305-398-7722.
Thank you.
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