Please print out this page, sign and date it, and return it via Postal Mail to:

Dr. Marlene Maheu
Self Help and Psychology Magazine
106 Thorn Street
San Diego, California 92103


General Release

Date: __________________________

Re: Permission to use and modify content of SH&P CyberRomance and Cybersex Essay Contest

Dear Dr. Maheu:

You have received my submission of personal information via email through your website form, or directly through private email. I understand that this information is to be considered a contest submission to possibly be used in connection with a book tentatively entitled CyberSexual Relationships & Affairs: Pros & Cons (the "Work"). I understand that I will be notified if I am a winner, and my submission will be used in the Work mentioned above. I also understand that my name and screen names will be changed to protect my identity, and that my identity will not be identified anywhere in this Work.

I hereby grant to you and Jossey-Bass Inc., Publishers (and its parent company, affiliates, licenses, and assignees), the latter being the contemplated publisher of the Work, the perpetual right and permission to edit, use, reuse, publish, and republish my statements and comments made by me as long as my name and screen name are not included, in whole or in part, without prior review, in all formats and media, now known or hereafter developed, of the Work and any derivative works, including without limitation electronic works and including for the purposes of worldwide sale, trade, promotion, or advertising.

I warrant the accounts told, written or furnished by me are original with me and do not violate any copyright, personal, or propriety right. I confirm that none of the information disclosed was acquired as a result of a confidential relationship or is treated as a trade secret.

I release you and Jossey-Bass Inc., Publishers from any and all claims, demand, or causes of action that I might assert in connection with the above use or uses by Jossey-Bass Inc., Publishers.

I am over the age of twenty-one. I have read the foregoing and fully understand the contents thereof.

Your Signature

Please PRINT the following information as clearly as possible.

Full Name

Street Address




Email Address



Return to the Contest Page

To buy a book on these and other topics, drop into the
Amazing Bookstore Catalog!

Want to comment? Express Yourself!


About SH&P | Articles | Advertise | Classifieds
Dear SH&P | Discussion Zone | FAQ | Kids Korner | Resources | Meditation
Post Cards | Professional | PsychToons | Reviews | Staff | Search | Submissions