Story Release Form – Gotta Be God

Name *

First

Last

EMAIL *

PHONE *

ADDRESS INFORMATION: *

ADDRESS INFORMATION:

Street Address

Address Line 2

City

State / Province

Zip / Postal Code

Country

Title of Story *

Terms

Textarea Field

I hereby grant Cheryl Shireman permission to use the “God story” I have submitted to her, or any part thereof, for publication in a book (printed form and eBook form) entitled Gotta Be God. I also grant Cheryl Shireman permission to use portions (or all) of the story for promotional purposes on any Gotta Be God related websites or through various social media sites such as Facebook and Twitter. I declare the statements I have made in my God story to be factual and true in their totality to the best of my knowledge.

I agree that I will not assert or maintain against you, your successors, assigns and licenses, any claim, suit, or demand of any kind or nature whatsoever including but not limited to, those grounded upon invasion of privacy, rights of publicity or other civil rights, or for any other reason in connection with your authorized use of my God story in the book as herein provided. I hereby release you, your successors, assigns and licensees, and each of them, from and against any and all legal claims, liabilities, demands, actions, causes of action(s), costs and expenses whatsoever, at law or in equity, known or unknown, anticipated or unanticipated, which I had ever had, now have or may, shall hereafter have by reason, matter, cause or thing arising out of your use as herein provided.

I understand that I will not be compensated in any way for the use of my story.

I have read the foregoing and fully understand the meaning and effect thereof and, intending to be legally bound, I have signed this release.

I HEREBY ACCEPT AND AGREE *

ACCEPT AND AGREE

By checking this box, I understand that I am electronically signing this form, and have read, agree to, and accept all terms of this form

SIGNED: *

Type your full, legal name as your signature

Please Enter