PERMISSION
TO USE QUOTE OR PERSONAL STATEMENT
FOR GOOD
CONSIDERATION, the undersigned irrevocably authorizes [r-Name], and
its successors and assigns to use, publish, or reprint in whole or in
part the following statement, picture, endorsement or quotation:
[s-Description]
This authorization
shall extend only to a certain publication known as [s-PubName],
including all new editions, reprints, advertisements, publicity and
promotions thereto of said work.
__________________________ _______________
Signature Date
