AUTHORIZATION TO USE COPYRIGHTED MATERIALS
By affixing my signature below, I certify that I am the true and lawful holder of the _____________________________________________________ copyright, granted _______________ (date), and I do hereby grant permission to ___________________ __________________________________________________ to publish, reprint, or excerpt this and only this material: _______________________________________ ___________________________________________________________________.
Such authorization granted only under condition that I be somehow credited in such publication as the author of said specified material.
_______________________________ Signed
_________________ Date