Creator's Permission for Use of Copyrighted Material

This form grants library staff permission to read or perform works by others as part of a library program. The form is not needed when authors or creators read or perform their own works.

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Description of Work(s)

Title(s) *

Author(s) *

Year(s) of publication *

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ISBN or other identifying information *

I Agree *

I certify that no other individual or parties hold copyright interest in the work(s) described above, that I hold all rights to the works listed, and that the license granted herein does not violate any third-party rights or applicable laws. If I am not of legal age, the signature on this form is that of a parent, guardian or other entity authorized to sign on my behalf.

I hereby grant Homer Public Library permission to use the copyrighted material(s) described above in public performance, including recording performance for preservation on the internet. The library will credit the copyright holder in announcements, recordings, or other public settings.

I understand that no monetary compensation will be provided in exchange for granting this permission.

I understand that this agreement does not in any way invalidate or rescind my copyright, and that I continue to hold the copyright until such time as I choose to surrender it.

Name & Signature (electronic) *

Date

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Phone *

Email *

Creator's Permission for Use of Copyrighted Material

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