CORWIN PRESS Visual Likeness Release Form
Request for Permission to Reprint/Adapt Material
[pic]
Date:
Dear :
I hereby request your permission to reprint a series of photographs (___ in total) taken by you for use in one of our upcoming titles.
Photographer:
Type of Excerpt: Photos
This material is to appear in the forthcoming book :
Title:
Authored/Edited by:
to be published by: Corwin
• Scheduled Publication Date:
• Estimated Total Print Run:
• Price:
I request nonexclusive distribution rights to include this material in the text and in future revisions, editions, and in all media thereof throughout the world. These rights in no way restrict republication of your material in any form by you or others authorized by you. If you do not control these rights in their entirety, please inform me of others to whom I should write.
CORWIN will include a credit line with the above information, unless you specify otherwise.
With appreciation of your time and cooperation,
Francesca Dutra Africano
I hereby grant permission for the use of the material as cited above.
Signed ________________________________ Date_________________
Printed_________________________ Federal ID or SSN______________
Permission release for minor:
I am the legal guardian and hereby grant permission for the use of my child’s material as cited above.
Signed ________________________________ Date____________________
Printed________________________________ SSN_____________________
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A SAGE Publications Company Tel: 805-499-9734
2455 Teller Road Fax: 805-499-2692
Thousand Oaks, CA 91320-2218
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