Release Form for Haiku Contest

Exclusive Permission to Use Poem and/or other literary work and photographs Subject: Winning Haiku

Location: Printed, spoken or electronic materials produced by or for the Woods and Waters Land Trust, Inc.

I hereby grant and assign to the Woods and Waters Land Trust, Inc. its representatives and employees, the royalty-free rights to use my submitted Haiku, entitled in printed, spoken and/or electronic format in Woods and Waters Land Trust, Inc. materials and/or events. Additionally, I grant to the Woods and Waters Land Trust, Inc. the right to use photographs taken of me during my submission and/or presentation of my work.

I agree that Woods and Waters Land Trust, Inc. may use such photographs, poem, or other literary work submitted by me, with or without my name and for any lawful purpose, including, but not limited to, such purposes as publicity, illustration, advertising and Web content.

I acknowledge that this work is original and has not been accepted by any other publisher. I acknowledge that the work is not libelous and does not infringe on any copyright or other proprietary right.

I have read and understand the above.

I understand that filling out this form constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.