Divinity of Dogs Story Submission Form

We respect your privacy.  Your personal details will not be sold to anyone.
*The following questions are asked to help refresh your memory and to help Ms. Skiff write/edit your story.  
This is about the moment you learned something profound or spiritually enlightening from your dog.  It cannot, unfortunately, be about a lifetime spent with your special dog.  Please tell us about that one "Aha" moment.

The provider promises the following story is truthful and understands no fee will be paid for use of the story.

If you would like your story to be considered for publication, we kindly ask you to read and agree to this release.  Thank you. 
RE:  The Divinity of Dogs by Jennifer Skiff (the "Book") For valuable consideration, hereby acknowledged, I hereby authorize Jennifer Skiff, Atria Publishing Group, a division of Simon & Schuster, Inc., and their licensees, successors and assigns, to use and publish my name, likeness, photographs of me, information and quotations from and about me (with possible editorial changes) and any copyrighted materials provided to you by me, including photographs and unpublished letters, in the above-captioned Book, in all editions, derivations and subsidiary uses of the Book in all forms and mediums whether now known or hereinafter devised, and in the advertising and promotion thereof, in all languages throughout the world and on this website.  I waive any right to inspect the Book.  I further waive any claims that I may have against Jennifer Skiff, Atria Publishing Group, and their licensees, successors and assigns, based upon the above use or uses, including without limitation any claims for invasion of privacy, violation of the right of publicity, libel and copyright infringement.  By checking off this box I understand that I am signing this form as if it were a hard copy.
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