I affirm that the novella __________________ (hereafter “the novella”) which I am submitting to the 2005 Pemberton Templeton 48-Hour Novella-Writing Contest (hereafter “the Contest”) is my own original work and that any resemblance the novella’s characters might bear to real persons, either living or dead, is entirely coincidental.

I also affirm that the novella was written entirely within the time constraints of the Contest. I understand that any breach of the Contest rules and regulations will render the novella ineligible for prizes.

I hereby give permission for the novella to be published in a volume of winners of the Contest in 2005, should the novella be chosen, and for the Contest’s organizers to quote up to 100 words from the novella in promotional materials, including those online. I understand that I will retain full ownership of the novella, and that any further publication of the novella by those associated with the Contest would require my express consent.

Name: __________________
Date: __________________