Release Form and Biographical Data
I, being known within the Society for Creative Anachronism as ________________________________________ _________________________________________________, do hereby grant permission for the (circle appropriate item(s)) article/poem/picture/song/artwork/other:__________________________) entitled _______________________________________________________ to be used in the Middle Kingdom’s unofficial Arts and Sciences journal, Artes Draconis, as follows (check all that apply, complete blanks where necessary):
__ Ownership by the publication titled Artes Draconis, and all copyright granted to that publication (or to Society for Creative Anachronism, Inc.), which shall determine all future use of the item, named above. (Check no other item in this list, if this option is specified)
__ Performance at the event called: ____________________________________________________________
__ One-time publication in an issue of Artes Draconis or: publication no more than ______ times (separate issues). **Please note that since Artes Draconis is available electronically as well as in hard copy, if you wish to have your article included in the electronic copy, please check both this and the following option**
__ Posting on the web page for Artes Draconis. I recognize that persons unknown may link to this site or may use my work without my permission. I shall hold the web page 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 three options, I retain all copyright in my work and may grant permission to any other publication or entity to use my work, or may withdraw permission as I choose. I understand that my article may be edited for grammar, spelling, punctuation, and for consistency with Artes Draconis’ editorial policies. 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 it I have based this upon the work of any person, their names and addresses (or other contact information) and the name of the original work are:
Date: _____________ Legal signature: ___________________________Address: _______________________________________________
Has this been printed elsewhere? Where and when? _________________________________________________
Biographical and Contact Information: Please tell us something about yourself and your Society persona, so that a brief biographical sketch can be composed for you.
Name: _____________________________________________ Telephone: _______________________________
Email: ____________________________ What contact info may we print with your article? (Please circle all that are appropriate): Name, address, email
Persona name: _______________________________________________________________________________
Local group/Kingdom affiliation: _________________________________________________________________
Titles, Awards, Offices (please give full name of award): ______________________________________________
Tell us a little about yourself: ______________________________________________________________
Tell us a little about your persona: __________________________________________________________
Please return this signed and completed form to: Artes Draconis; c/o Karen M. Johnson, 310 County Rd. 1675, Jeromesville, OH 44840.
Contact me if you have any questions!