JACK M. FREEDMAN
92 Parkview Loop Staten Island, NY 10314 (347) 276-0915 email@example.com
To: Contributors to “Trails Through The Greenbelt” anthology
From: Jack M. Freedman, Editor
Thank you for your contributions to the anthology. It is gratifying that so many authors and artists with
connections to Staten Island have shared their work with all of us.
It is necessary that you sign the following agreement in order that your contributions be included in the
I give consent that my contribution be published in the anthology.
I affirm that I am the original author of the following titles (please list titles)
I understand that the anthology will be copyrighted in the name of Jack M. Freedman,
I will retain all rights to my personal work and may copyright my own work if I choose to do
If I wish, I may submit a 50-word autobiographical statement to be printed in the anthology.
This statement will be written on Page 2 of this agreement and mailed to Jack. SNAIL MAIL
I understand that if I do not mail this signed agreement to Jack, my work will not be
included in the anthology. I agree to return this form by July 1 st, 2007. NO EXCEPTIONS!!!
I will return this agreement to Jack or mail it to the address shown above. Any questions
can be directed to Jack by e-mail or phone.
Please provide your e-mail address, your home address, or your phone number so that we may notify
you when the anthology is published.
CONTACT INFO: ________________________________
Please return both pages of this agreement.
Thank you once again for all you have done to make our anthology a reality.
Jack M. Freedman
Editor of “Trails Through The Greenbelt”
AUTOBIOGRAPHICAL STATEMENT (Optional)