Permission to use copyrighted material

COPYRIGHTED MATERIAL FOR GOOD CONSIDERATION, the undersigned, as copyright holder, hereby grants permission to _, to reprint, publish and use for world distribution the following material: (Describe or attach) _ This material shall be used only in the following manner or publication: (Define intended use) _ A credit line to acknowledge use of the material is _____ is not _____ (Check one) required. If required, the credit line shall read as follows: _ Dated: _ _______________________________