PERMISSION TO USE COPYRIGHTED MATERIAL FOR GOOD CONSIDERATION, and in consideration of the sum of $ to be paid herewith, the undersigned, as copyright holder, hereby grants permission to to reprint, publish and use for world distribution the following material: This material shall be used only in the following manner or publication: A credit line to acknowledge use of the material is/is not required. If required, the credit line shall read as follows: This agreement shall be binding upon and inure to the benefit of the parties, their successors, assigns and personal representatives. Signed this day of , (year). In the presence of: ____________________________________ __________________________________ Witness Name