Anthology Contribution Release Form

Title of Work:
Author's Name:
Email Address:
Phone Number:
Mailing Address:

Grant of Rights

I hereby grant permission to publish my work titled above in the anthology. I affirm that the work is my original creation and does not violate any copyright or other rights. I permit the publisher to include the work in printed and electronic versions of the anthology. All rights not explicitly granted remain with me, the author.

Additional Notes or Restrictions

Signature of Contributor
Date