Please PRINT this form (from your "File" Menu), fill in the blanks, and MAIL IT, along with 3-D prints, to:
Attention: Jon Grieg
SPECIAL INTEREST TELEVISION
P. O. Box 468
NORTH HOLLYWOOD, CA 91603
If you prefer sending images by e-mail, we still need to have this signed release. Please don't e-mail the pictures without telling us first. When we receive this form, we can also grab any images that you indicate from your web site.
The undersigned hereby declares that
he/she is the sole copyright holder, or has full power of decision over
the (fill in: image, article, etc.) ___________ titled _________________________
previously published or released in
/ on __________________________ (month: ______, 199__).
If you are sending more
than one image, please list additional titles on the back.
By signing this release you are granting to Jon Grieg and Special Interest Television and to their associates and representatives a non-exclusive permission, for an unlimited period of time, to reproduce the above-mentioned copyrighted material in connection with the publishing, distribution, exhibition, marketing, and exploitation of the "mindhelp.com" Internet site and any related products in any manner whatsoever, at any time and in any part of the world. You agree that the above-mentioned material, if published, can be modified and / or altered as needed. You understand that Jon Grieg and Special Interest Television will list your name as an author or copyright holder in any circumstance where the above-mentioned material will be published, excluding brief quotations, marketing materials, or, in the case of written materials, if the wording has been modified more than 50% (fifty percent).
No other warranty or liability is assumed by Jon Grieg, Special Interest Television, or their representatives. Where applicable, an Internet link can be included on the mindhelp.com Internet site, at the same location with the above-mentioned material, to another WEB site or Internet page belonging only to the author or copyright holder. The publishing of 3-D demos is free; only suppliers who get orders worth over $2,000 as a direct result of this exposure are required to pay a 10% commission / honor basis.
This release is non-exclusive, which means that the author or copyright holder can continue to publish or exploit the above material in any manner whatsoever - but without putting Jon Grieg and/or Special Interest Television in a liability position towards a third party, such as another Publisher or Media Producer. This Release represents the full agreement between the undersigned and Jon Grieg / Special Interest Television, and it is binding unless a more detailed Agreement regarding the above subject is written and signed at a later date. Note: Publication of submitted materials is subject to artistic evaluation.
Please sign and fill in the required
information (on top & below). Make sure it's
HIGHLIGHT or CIRCLE the items that
you want INCLUDED in the Author Index.
Print name ___________________
Signature _____________ Date ________
Address _________________________________________________________
City, State, ZIP, Country____________________________
e-mail __________
WEB page _____________________
Phone ____________ FAX __________
I would like my caption
to say " ©, 19___, _____________________________
Enclosures: Brief Bio? ___
Brief Item Description? ___ Other? __________________
(If permission is granted for a minor:
Minor's Name _____________________________
Age ____ Relationship to person
who signed above _____________________________)
|
|