Writer's Release (Subsequent Publication)

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The Fairfield Review
Writer's Background Information and Release
Subsequent TFR Publication

For writer's who have previously publsihed their work in The Fairfield Review, please tell us any updated information, and sign this release for your latest work.

1.	How would you like your name to appear in the magazine? _____________________________________________________________
2.	What is your mailing address? ___________________________________ ______________________________________________________ Email address? __________________________________________ Telephone number? ______________________________________
3.	Any other information we should have about your work when it is published? (e.g., additional credits or awards for your biographical sketch, required copyrights, trademarks, footnotes, etc.) _____________________________________________________________ _____________________________________________________________
4.	Do we have your permission to include your work in The Fairfield Review, an on-line magazine published on the Internet's World Wide Web, and do you hereby certify that it is your original work, and hold The Fairfield Review Inc., its editors and employees harmless against any lawsuit that may result from the publication of this work? ____________________ (Yes or No?)

Signature: _________________________________	Date: ____________________
Name (please print): _________________________	Phone number: ____________
Parent or Guardian Signature: _________________________________ (if under the age of 18)	Date: ____________________

Fax this completed and signed form to The Fairfield Review
at 203-255-6139 or mail it to:
The Fairfield Review
c/o Edward Granger-Happ
544 Silver Spring Road
Fairfield, CT 06824

The Fairfield Review is published by the Fairfield Review Inc., a non-profit corporation.