I hereby submit my original and previously-unpublished writing (the “Work”) to Holly R. Corcoran (“HRC”), RR#3 Box 2477, Effort, Pennsylvania 18360, for consideration for inclusion in her proposed book currently known as “Dear Women: Inspirational Letters from Women to Women on Life, Love, and Learning” (the “Book”).

I hereby irrevocably grant, transfer, and assign to HRC, her successors and assigns, in perpetuity, all right (whether now known or hereinafter invented), title, and interest, throughout the world, including any copyrights and renewals or extensions thereto, in the Work, and in and to all works based upon, derived from, or incorporating the Work, and in and to all income, royalties, damages, claims and payments now or hereafter due or payable with respect thereto.

I understand that I will receive no monetary compensation from HRC for the assignment of the copyright, nor for any publication of the Work. I understand that the Work may be published in whole, in part, or not at all. I understand that the Work may be published apart from the Book and may be published electronically.

I certify that the Work is my original work, has not been published before and is not being considered for publication elsewhere, and that I have obtained permission for and acknowledged the source of any excerpts from other copyright works.

This Publication Request and Agreement is subject to and to be construed under the laws of the Commonwealth of Pennsylvania.

Intending to be legally bound, I have signed this Publication Request and Agreement as of the day of , 20 .