I, ___________________________________________________________________________

being known within the Society for Creative Anachronism as:

_______________________________________________________________________________

do hereby grant permission for the (circle the submission type):

article / poem / picture / song / other (describe) _________________________________________

entitled: ________________________________________________________________________

_______________________________________________________________________________

to be used by the newsletter, The Cataract. 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 contact information is:

_______________________________________________________________________________

_______________________________________________________________________________

Date: __________________________________________________________________________

Signature: ______________________________________________________________________

Address: _______________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________