LICENCE TO USE FORM

Please fill in the form below

I give Ballad Of… the absoloute right and permission to use my work in publication and online format in exchange for full credit acompanying my work. I understand that work may be altered slightly to fit dimensions of the publication and may be used in conjunction with other artists under any title with full agreed credits. I certify I will get this form signed and returned to Ballad Of… within one week of receiving it.
Full Name:
Date of Birth:
Address: (just to ensure we don’t lose touch, no junk mail or unnecissary calls & they won’t be published!):
Telephone Number:
Email:
DESCRIPTION & DATE OF WORK (so we don’t get mixed up and can © accordingly):
TITLE OF WORK(S) (it can be untitled, so don’t just name it for the sake of things! you don’t want to risk its quality by using a dodgy name!):
CREDITS (who you want to credit alongside your work. write it as you wish it to appear. you MUST write your name here but just your name? your website? did anyone else help? include models, photographers, make up, hair stylists, illustrators etc :P):
ABOUT ME (we need to put a bit about you on the contributors page what do you do? how do you do it? 100 words please):
I WANT MY DETAILS TO BE PRINTED IN THE BALLAD DIRECTORY (the bit at the back of the magazine…it’ll be your name, talent and e mail address)	Yes No
URL OF A PHOTO OF MYSELF(again for the contributors page. the photo MUST be of you. it can be artistic, ancient or abstract, but it MUST be of you)[PLEASE UPLOAD TO A IMAGE PLACE AND PUT IN THE URL-YOU CAN USE FLICKR/TINYPIC/WHATEVER]
I CONFIRM THAT ALL WORK RECEIVED BY BALLAD OF… IS MY OWN:	Yes No

THANKS DARLIN XXX