Just Plain Pix Catahoula Photo Release Form

The Undersigned hereby grant(s) permission to Just Plain Pix                 (hereinafter

referred to as the “Designer”), located at PO Box 638 Strasburg, CO 80136, and

to the Designer’s successors and assigns, to use the material specified in this Permission Form for the following product Catahoula Christmas/Note Cards for use by the following publisher or client Just Plain Pix.

This permission is for the following material:

Nature of material Photograph

Photographer _____________________________________________________________________________________________

Description of photograph _______________________________________________________

If published, date of publication __________________________

Publisher _____________________________________________

Author(s) _____________________________________________

This material may be used for the product named above and in any future revisions, derivations, or editions thereof.

It is understood that the grant of this permission shall in no way restrict republication of the material by the

Undersigned or others authorized by the Undersigned.

If specified here, the material shall be accompanied on publication by a copyright notice as follows___________________

_______________________________________________________________________________________________________________________ _______

and a credit line as follows _____________________________________________________________________________.

Other provisions, if any: __________________________________________________________________________________

If specified here, the requested rights are not controlled in their entirety by the Undersigned and the following owners

must be contacted: ______________________________________________________________________________________

__

One copy of this Permission Form shall be returned to the Designer and one copy shall be retained by the

Undersigned.

___________________________________________________ ____________________________

Authorized Signatory Date

Just Plain Pix Permission Form 101