The Undersigned hereby grant(s) permission to ______________________________________ (hereinafter referred to as the "Photographer"), located at ________________________________________, and to the Photographer's successors and assigns, to use the material specified in this Permission Form in the following book, product, or use for use by the following publisher or client: ___________________________________________.

This permission is for the following material:

_____________________________________________

Nature of material: ______________________________________

Source: ______________________________________________

Exact description of material, including page numbers: _______________________________

If published, date of publication: __________________________

Publisher: ___________________________________________

Author(s): __________________________________________

This material may be used in the Photographer's book, product, or use named above and in any future revisions, derivations, or editions thereof, including nonexclusive world rights in all languages.

It is understood that the grant of this permission shall in no way restrict republication of the material by the Undersigned or others authorized by the Undersigned.

If specified here, the material shall be accompanied on publication by a copyright notice as follows: (C) BY _______________________, 19____.

and a credit like as follows: ____________________________________________________.

Other provisions, if any: ______________________________________________________.

If specified here, the requested rights are not controlled in their entirety by the Undersigned and the following owners must be contacted:

_______________________________________________________

_______________________________________________________

One copy of this Permission Form shall be returned to the Photographer and one copy shall be retained by the Undersigned.

__________________________________ ________________________

Authorized Signatory Date

__________________________________ ________________________