General Release

I hereby grant the owner of The Underground Mine my permission to reprint on their website the creative work I submitted to The Underground Mine. 

I further certify that I am the sole owner and creator of said submission.  I understand that no royalties will be paid to me for use of my work by The Underground Mine.

I understand that I will retain all rights, copyrights and ownership of my original works and that I am granting The Underground Mine the right to publish my work only.   The Underground Mine agrees it is not authorized to sell my work. 

I understand the Internet is a public forum and if my original work is copied from The Underground Mine and/or reprinted elsewhere, I agree to HOLD HARMLESS The Underground Mine.

I have read and agreed to the terms above and I certify I am above the age of 18 years old. (If under age 18 please have a parent or guardian certify your agreement).

First Name:

Last Name:

Address :

City:

State:                              Zip:

Signature:                                                                              Date:     /    /

(If e-mailing form put date of birth on signature line)

Please include any information you authorize and would like published about yourself; i.e. your interests, your contact info etc. when we publish your work.

Please send completed form by e-mail to:

submissions@undergroundmine.com

By mail to:

Celeste

c/o The Underground Mine

160 S. Gramercy Pl #605

Los Angeles CA 90004