Permission To Use Copyrighted Material

FOR GOOD CONSIDERATION, the undersigned, as copyright holder, hereby grants permission to ________________, to reprint, publish and use for world distribution the following material:

(Full description)

This material shall be used only in the following manner or publication:

A credit line to acknowledge use of the material is ___ is not ___ (check one) required. If required, the credit line shall read as follows:

Dated:

Signed:________________________

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