Submission Acceptance / Release

(For use by minors and their parents/guardians.)

 

Please fill out and return this form

It can be mailed to:

Mary S. Biesecker Public Library

Att: Teen Advisory Board

230 S. Rosina Ave.

Somerset, PA 15501

 

Or, you can sign, scan, and e-mail it to: tony@maryslibrary.com

 

I hereby release the following work:

(Title) _______________________________

To be reviewed for inclusion in the MSBPL TAB Newsletter. This is not a guarantee of submission acceptance. It is possible for submissions to appear in our print newsletter and on the library’s website. By signing this form you and your parents/guardians give first serial and online publication rights * and anthology reproduction rights to the Mary S. Biesecker Public Library and do allow for the use of your name and brief biography in print. You, the submitter, retain the copyright and all other rights to the piece provided. By signing I agree to the above terms.

 

Creators Signature: ________________________________________ Date: ____________________________

 

 

Parent/Guardian Signature: __________________________________ Date: ____________________________