Permission Form

If you plan to submit a story (or other content) for publication on this Web site or if you wish to submit a comment for our Feedback pages and you wish to have us credit you for your contribution by name, you need to complete and return a permission form.

Here is a copy of the permission form in PDF format. Click here or on the icon to the left to download.

You will need a copy of Adobe Acrobat Reader to open and view the permission form you download. If you don’t already have a copy, you can click on the image to the left and download a free copy from Adobe. You can download the files on a dial-up account, however a broadband connection is recommended.

If this is a problem, you can simply print out this page. A copy of the permission form follows, with directions for sending it in with your contribution.

PERMISSIONS AGREEMENT

(Please print clearly.)

Agreement between:
Contributor’s Name: ________________________________

Address:

___________________________________

___________________________________

and Jane Bluestein, Ph.D. and Eric Katz, M.S.A.C. (Authors), entered into on this day _____ of ____________ of the year __________.

Contributor agrees to grant the AUTHORS use of the contributed material to be used in whole or in part on a website titled www.highschoolsnotforever.com which is connected to the book being published by Health Communications, Inc., entitled HIGH SCHOOL’S NOT FOREVER.

Agreed to: _____________________________ Age ____

(Contributor’s Signature) Birthday ___/___/___

Parent’s Signature if Contributor is under 18:

________________________________ (Parent’s Signature)

________________________________
(Parent’s Name, Please Print)

Email: _________________________
Home Phone: (____) _______- ____________
Cell Phone: (____) _______- ____________
Work Phone: (____) _______- ____________

Attribution (credit)

___ Credit my contribution with my full name (Parental Permission required if under 18)
___ Credit my contribution with my first name (Parental Permission required if under 18)
___ Credit my contribution anonymously (using fake first name or possibly attributed to “anonymous”). Authors will use this option if no preference is specified, or if appropriate permissions are not provided.

Please return this signed agreement:

By mail to:
High School’s Not Forever
1709 Father Sky Ct NE • Albuquerque, NM 87112

By fax it to: 505-323-9045

Or send scanned, clearly-signed copy to us by email. (Click to send an email or call 1-800-688-1960 for our email address.)

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