I, the undersigned, give my permission, for the one time only publication of the manuscript listed below, to be published by the Oasis Writers' Guild. I understand that publication may be as print media or as an electronic document on the Internet. All other copyrights are reserved by me. I do (_____) do not (_____) authorize creation of an eBook from my work. (Please initial in the appropriate block)
I further state that this is my own original work, and any use of non-fictional characters, living or dead, is with written authorization, and I absolve the Pseudonym publishers of any liability for their use.
(Please print all information clearly, we thank you.)
Title of work submitted:.................................................................
Type of work:.................................................. (poem, short-story, etc.)
Date submitted:..........................................................................
Name:....................................................................................
Address:.................................................................................
City:......................................State...............ZIP.......................
Phone: (.........)..........-...............................Ext (if any)....................
A copy of authorization to publish copyrighted items, or items containing non-fictional characters is enclosed (when applicable).
Print this form and complete all applicable information. Send or deliver to:
Oasis Writers' Guild
PO Box 6524
Pahrump, NV 89041