Author’s Release Form
Author Full Name
First Name
Last Name
Email Address
example@example.com
The Title of the Book
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Permissions
Third Party Materials include only videos, photos, illustrations, diagrams etc.
Third Party Material Usage
I have not used any material from a third party.
I have permission to use the materials that listed below.
List of Materials Used in the Book
Government Work
This declaration certifies that this book is not protected by copyright in the United States, if it was published as part of your work for a government agency that does not allow copyright.
Agency Name
Government
Signature
Submit
Should be Empty: