PERMISSION TO USE QUOTE OR PERSONAL STATEMENT FOR GOOD CONSIDERATION, the undersigned irrevocably authorizes _, and its successors and assigns to use, publish or reprint in whole or in part the following statement, picture, endorsement or quotation: (Describe or attach) _ This authorization shall extend only to a certain publication known as _, including all new editions, reprints, advertisements, publicity and promotions thereto of said work. Dated: _ _______________________________