This form may be completed and e-mailed to an SCA publication for immediate use. However, if you use this on-line form, it is in trust that you will be forwarding a SIGNED form to the publication. SCA publications must have your signature on file to use your material.
I, , being known within the Society for Creative
Anachronism as , do hereby grant permission for the (Circle appropriate
item(s): article/poem/picture/song/other ) entitled:
to be used as follows (check all that apply, complete blanks where
necessary):
Ownership by the publication titled and all copyright
granted to that publication (Society for Creative Anachronism, Inc.), which
shall determine all future use of the item named above. (Check no other
item.)
One-time
publication in an issue of:
or: publication
that publication no more than times
(separate issues).
Performance at the
event called
Posting on the Web
page for:
I recognize that persons unknown may link to this site or may use my
work without my permission. I shall hold the web page owner harmless from
such activity if proper notice appears on the Web page, and I am immediately
notified when the link or use is discovered.
If I have checked one of the last three options, I retain all copyright
in my work and may grant permission to any other publication or entity to
use my work.
I further certify that I am the sole creator of this work, and have not
substantially based it upon the work of any other person. If others have
contributed to this work, or if I have based this upon the work of any person,
their names and addresses (or other contact information) are:
Date: //
Signature: (Signature
must be on completed and mailed form.)
Address: