For good consideration, the undersigned irrevocably authorizes _____________________ , and its successors and assigns to use, publish or reprint in whole or in part the following statement, picture, endorsement or quotation: __________________________________________________ (Describe or attach)
This authorization shall extend only to a certain publication known as __________________________, including all new editions, [...]
For good consideration, the undersigned, as copyright holder, hereby grants permission to ____________________, to reprint, publish and use for world distribution the following material: _____________________________________________________ _____________________________________________(Describe or attach).
This material shall be used only in the following manner or publication: _____________
_________________________________________________________ (Define intended use).
A credit line to acknowledge use of the material is [...]
