___________Blossom Publishing Company___________
PO Box 390
Wasco, Illinois 60183

Assignment, Acknowledgement and Release

This Assignment, Acknowledge and Release is executed by the undersigned contributor (hereinafter, “Contributor”) in favor of Blossom Publishing Company. In consideration of possible publication or republication or other use of the material submitted by Contributor, and other good and valuable consideration, the sufficiency of which the parties hereby acknowledge, Contributor hereby represents, agrees and acknowledges as follows:

1. Contributor represents and warrants that all of the published material submitted by Contributor is Contributor’s original work, never before published, and that the Contributor possesses all right, title and interest in all material submitted, including without limitation all copyrights.

2. By submitting the material to Blossom Publishing Company, Contributor assigns all of his/her right, title and interest in the material, including copyright, to Blossom Publishing, Inc. Contributor hereby consents to the publication and/or republication or other use of the material by Blossom Publishing Company, in the event that Blossom Publishing Company, in its sole discretion, chooses to publish or republish the material.

3. Contributor agrees and acknowledges that, upon submission of the material and all rights and interest therein, including copyright in the material and any and all benefits resulting from the publication or republication or other use of the material will become solely the property of Blossom Publishing Company.

4. Contributor agrees and acknowledges that upon submission of the material to Blossom Publishing, Inc., he/she releases any claim or any right whatsoever to payment of remuneration, including royalties, for the material.

5. Contributor agrees and acknowledges that in the event contributed material is used in Blossom Publishing Company publication, name recognition for the materials will be solely at the discretion of Blossom Publishing Company. In the event name recognition is used with the contributed material, credit for the contributed material will consist solely of printing the name and city of the contributor.

SUBMISSION OF MATERIALS BY CONTRIBUTOR CONSTITUTES ACCEPTANCE OF ALL TERMS AND CONDITIONS OF THIS AGREEMENT.

Contributor (Please sign, and fill out information below)

____________________________________ __________________
Signature Date


Title or brief description of submitted material __________________________________________________
______________________________________________________________________________________
__________________________________________________________________________

Submitter’s name _________________________________________ Phone # _____________________
Address _______________________________ City ________________ Country __________________
State _______ Zip/Postal code ______________ e-mail ______________________________________

I do not want my name to appear in any Blossom Publishing Company publication.


Please send this Assignment, Acknowledgment and Release along with your typed materials to:
Blossom Publishing, PO Box 390, Wasco, Illinois, 60183.

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