I Didn’t Get Old Being Stupid
MATERIALS RELEASE FORM

All authors must return a signed Materials Release Form before their submissions will be considered for inclusion in I Didn’t Get Old Being Stupid.

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to return with your submission.

None of the personal information requested below will be published. This information will only be used by the Publishers
to contact selected authors.

Name: _________________________________________ Age: ________

Address: ____________________________________________________

City: _____________________________ State: ______ Zip: __________

Phone number: (________) _________ - _____________

E-mail Address [i.e.: yourname@aol.com]: _______________________

Title of submission: ___________________________________________

The signature of the Author gives Miles To Go Productions (the “Publishers”) the right to reproduce, publish and distribute his/her work (collectively, the “Material”) under the terms and conditions listed below.

Your signature on this Materials Release Form:

1. Grants the Publishers the right to exercise a contract to reproduce, publish and distribute the Material (including all text and any accompanying drawings, photographs, or other images identified by name, in all forms, including books, magazines, electronic databases, and online transmission) exclusively from the date indicated on the signed Materials Release Form forward in perpetuity, in return for compensation to the Author in the amount of one hundred US dollars ($100.00).

2. Assures the Publishers that the Material is original and was created by the Author, unless on the Material it has been identified in writing those parts that are quoted or reproduced from other sources.

3. Assures the Publishers that none of the Material has been published before and/or that exclusive permission has not been given any other person or organization to publish the Material, and that no other permission will be granted for said Material.

4. The Publishers reserve the right to edit, revise and condense the Material, as it deems necessary for space, grammatical accuracy and style preference. The Publishers shall also have the right to change the title of the Material in their sole discretion. The Publishers will credit the Author of the Material whenever it is published or reproduced.

5. By submitting their Material, Authors consent to the use of the Material, excerpts thereof, and their names for publicity purposes without compensation.

6. All Authors whose Materials are selected for publication will receive a complimentary copy of the book I Didn’t Get Old Being Stupid.

7. The Publishers hereby disclaim any responsibility for lost, stolen, interrupted, misdirected or un-received mail or electronic transmissions.

Author’s Signature: _______________________________ Date: _______

Author’s Printed Name: ________________________________________

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