Publication Permission Form

Society for Creative Anachronism, Inc.


This form may be completed and e-mailed to an SCA publication for immediate use. However, if you use this on-line form, it is in trust that you will be forwarding a SIGNED form to the publication. SCA publications must have your signature on file to use your material.

I, , being known within the Society for Creative Anachronism as , do hereby grant permission for the (Circle appropriate item(s): article/poem/picture/song/other ) entitled:
to be used as follows (check all that apply, complete blanks where necessary):

Ownership by the publication titled and all copyright granted to that publication (Society for Creative Anachronism, Inc.), which shall determine all future use of the item named above. (Check no other item.)

One-time publication in an issue of:
or: publication that publication no more than times (separate issues).
Performance at the event called
Posting on the Web page for:
I recognize that persons unknown may link to this site or may use my work without my permission. I shall hold the web page owner harmless from such activity if proper notice appears on the Web page, and I am immediately notified when the link or use is discovered.

If I have checked one of the last three options, I retain all copyright in my work and may grant permission to any other publication or entity to use my work.

I further certify that I am the sole creator of this work, and have not substantially based it upon the work of any other person. If others have contributed to this work, or if I have based this upon the work of any person, their names and addresses (or other contact information) are:

Date: //
Signature: (Signature must be on completed and mailed form.)
Address: