Publication Permission Form
Society for Creative Anachronism, Inc.

I, , being known within the Society for Creative Anachronism as , do hereby grant permission for the (Circle appropriate item(s): article/poem/picture/song/other ) entitled:
to be used as follows (check all that apply, complete blanks where necessary):

Ownership by the publication titled: (Society for Creative Anachronism, Inc.) and all copyright granted to that publication, which shall determine all future use of the item named above. (Check no other item.)
or: One-time publication in an issue of:
or: Publication no more than times (separate issues) of:
Performance at the event called
Posting on the Web page located at and/or in the galleries for located at

I recognize that persons unknown may link to this site or may use my work without my permission. I shall hold the web site owner harmless from such activity if proper notice appears on the Web page, and I am immediately notified when the link or use is discovered.

If I have checked one of the last four options, 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 names and addresses (or other contact information) are:

Date: //
Signature: (Signature must be on completed and mailed form.)