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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?

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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: ____________________

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The Fairfield Review
c/o Edward Granger-Happ
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Document last modified on: 08/23/2000