I
am writing a metaphysical book and would
like to include the experiences of some of my clients. If I have read for you
or if you have attended an online workshop and you'd like your
experience with me to be considered for inclusion in my book please fill out this form
completely. (Incomplete forms will not be considered.) While I will try to include everyone that
would like to participate, the actual page length of the finished
print book may limit the number of individual experiences included.
This
form acts as both a release form, which gives me permission to use
your experience in my book, and a submission form to send me the
information by email. All submissions are subject to basic editing
for typos, grammar etc.
Please
complete the following:
Your
Name:
I
respect the privacy of my clients. I understand that some of you
would like to participate but prefer to keep your real name private.
I have given three selections, please choose one here:
If you chose to keep
your real name private, what first name would you like for me to use
in the description of your experience?
Today's
Date:
Your
Reading Experience: This can be as brief or as long as you would
like it to be. Some things you may wish to include are why you were seeking a clairvoyant,
details of the reading or your experience during the workshop, how the reading/workshop impacted you, the course you
chose to take after the reading/workshop and any impact it had on your life
overall. Anything that you would like to include that you feel would help someone else learn from
your experience. This is your experience, you can tell others
whatever is important to you when it comes to a psychic reading or
developing your abilities.
- Mailing
Address:
- City:
State:
Zip:
- E-mail
Address:
- Alternate
E-mail Address:
- Phone
Number:
Permission
to Use This Submission and Release Form: I
understand that I hereby grant Melissa Alvarez and the future
publisher of her metaphysical book, the right to publish some or all of my
experience(s) with Melissa Alvarez in her metaphysical book .
If selected for inclusion, the publisher will publish my name and
opinion of my experience, in whole or in part, in the various book
and ebook formats as chosen by the publisher. The publisher has
the right to edit, revise, abridge and condense the material for
space reasons and to reuse the material for promotional and
advertising purposes. If selected for posting on the publishers or
Melissa's website, the website posting has no established
beginning or end date, and the material may be included in archives.
I
authorize Melissa Alvarez and the publisher of her book to utilize the information
contained in this electronic submission as my testimonial and
understand that payment will not be made for use of this submission
but that I will be given credit by being named within the book’s
text if I chose to use my name. By this document, I release the
publisher and Melissa
Alvarez, their agents, employees or assigns from any and all claims
for damages, for libel, slander, invasion of privacy or any other
claim based upon my submission.
I
warrant that I own all rights and interest in my experience as
submitted, and that the submission will not infringe on or violate
any copyright of any third party.
Upon
acceptance of submission to publisher, I understand that rights to
my testimonial transfer to said publisher.
I
agree to contribute the text included in this submission to
Melissa's metaphysical book if selected for inclusion:
Electronic
Signature. By typing my name in full I understand that I am legally bound by this document.:
(SEAL)
Retype
your electronic signature here for confirmation of release agreement:
(SEAL)
Today's
Date:
(SEAL)
