YMAA Review Product Team Survey

Testimonial Permission Form

First Name

Last Name

Title (i.e.) author, level of martial arts, other title

Address

Address 2

City

State

Zip Code

Office Phone

Fax

Books or other materials you have authored/credentials

Your testimonial

Date of testimony

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Please completely read this form. Please fill in your contact data, name, and title. Our goal is to assure that attribution to you is correct and favorable and that our audiences will be able to obtain your works easily, quickly, and confidently.

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By completing this form you grant permission for YMAA Publication Center, Inc., to include the excerpt(s) as outlined including but not limited to versions of the book in hard cover, soft cover, e-book, book club, and special editions for the handicapped such as Braille, large type, and video and audio tapes, in all languages, and in the advertisement and promotion therefore, non-exclusively throughout the world.