STANDARD DISCLOSURE FORM | ||
---|---|---|
a) I wish to submit the following materials for consideration for publication by Brittannia Game Designs Ltd, subject to all of the conditions below. Working title of submission and brief description: _____________________________________________________________ _____________________________________________________________ |
||
| ||
Has never been published | ||
Has been published. | supply information on back of this form (name of publication, date etc and if possible provide a copy. | |
I further warrant that the submission is original, and that its publication will not violate the rights of any third party, and that the person identified herein as the submitter is the sole owner of the submission.
Furthermore, I am of legal age and am free to make agreements relative to this submission, or I am the authorised representative of the submitter: |
Signature: ___________________________ Relationship to author if not author: ______________________
Date: _______________________________
Please type or print the following:
Submitters name: ________________________________
_______________________________________________________________________________________
Telephone: _____________________________________
E-mail: ________________________________________