Permission to Publish Form (Online, 2010)

If your artwork or writing submission is accepted for publication, we will post your work on the SpeakOut 2.0 website. The goal for publishing your writing is to celebrate and circulate your voice, style, and experience with others and to increase awareness about the issues that your writing explores. Sharing your writing is a way to command respect for your experiences and take pride in your writing and creativity. We would like your permission to do this.

There are two ways to "sign" your name to your work on the SpeakOut! 2.0 website. Per our policy, we do not use full names as to protect the identity of individuals who wish to publish their work. Please choose one of the following methods:

1. First name and last initial: i.e. Jane D.

or

2. A pen name of your choozing: i.e. "Jane-sanity"

The name I wish to use for my publication is:

PLEASE FILL OUT THE FOLLOWING FORM

First Name:

Last Name:

Email Address:

By signing your first and last name in the box below, you understand that the team at SpeakOut! 2.0 will select only work that you (the writer) have approved for publication. The website admins will make every effort to reproduce your work in the format that you indicate. You also give us permission to publish your work on SpeakOut 2.0! You will retain creative rights to your own work (in short, you can submit your work in other venues if you so desire).

Electronic Signature:

Date (please use format: 01/01/2010):

ATTENTION! WRITERS WHO ARE SUBMITTING THROUGH POSTAL MAIL . . .

If you are submitting through "snail" mail (i.e. through the post-office) please provide an address if you wish your pieces (in their original form) to be returned to you via the postal service. If you do not include an address and do not wish for your work to be returned to you, we will keep hard/original copies for 6 months and then dispose of them.

Street Address:

City:

State:

Zip: