RIGHTS-HOLDER PERMISSION FORM

Title of Essay _________________________________________________________________________________
Entrant(s) Name(s) ____________________________________________________________________________
Entrant(s) Address(s) __________________________________________________________________________
Address _____________________________________________________________________________________
City __________________________________ State _______ Country _____________ Zip/Postal Code __________
Entrant(s) Phone Number(s) _____________________________________________________________________
Entrant(s) E-Mail Address(s) _____________________________________________________________________
Rights-Holder Name ___________________________________________________________________________
Name and Title of Contact Person ___________________________________________ Title __________________
Rights-Holder Address _________________________________________________________________________
City __________________________________ State _______ Country _____________ Zip/Postal Code __________
Rights-Holder Phone Number ____________________________________________________________________
Contact's E-Mail Address ________________________________________________________________________
Title, Date and Place of Previous Publication of Essay (if applicable)
_____________________________________________________________________________________________
The above-named individual or entity is the Rights-Holder of the essay as follows:
Copyright Owner	Exclusive Copyright Licensee
Other (explain): _____________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
AUTHORIZATION: In the event this Essay wins an award in the Power of Purpose Awards, A Worldwide Essay Competition, the undersigned on behalf of the Rights-Holder hereby grants to Power of Purpose, LLC (the "Company") and to its successors, assigns, and authorized licensees, the non-exclusive royalty-free right and license, for a period of five (5) years after the date that the Company publicly announces the Award-winners, to publish, reproduce, and publicly perform the Essay throughout the world, in whole and in part, in all print, electronic, online, digital, broadcast, and other media, whether now known or hereafter devised. Such Entrant, and as applicable the Rights-Holder, shall retain the copyright in and to the Essay. The Company has no objection and encourages the Entrant or Rights-Holder, as applicable, to publish, reproduce, copy, display, and publicly perform the Essay during and after the five year term of the Company's license; the Company requests that it receive written notice from the Entrant or Rights-Holder when the Essay is published, publicly displayed or publicly performed during the five year term of the Company's license. If the Essay is not an Award-winner, the Rights-Holder does not grant the Company the license described herein.
Signature of Authorized Representative
_____________________________________________________________________________________________
Printed Name: _________________________________________________________________________________
Date: __________ /_________ /________
At the Company's request, the Entrant must print this form, have it signed by the Rights-Holder, and fax or mail it to:
Power of Purpose LLC, 5105 Peachtree Ind. Blvd., Suite 250, Atlanta, GA 30341
Fax Number: (770) 234-9338
Failure to complete and return this Rights-Holder Permission Form within 14 days after the Company's request will result in disqualification of the Essay; the Company reserves the right to extend this time period in its discretion.
Signatures submitted by facsimile will have the same legal effect as original signatures.