Contribution: Provide a Detailed Description of the Material to Be Used, and Attach a Copy

______, 2014

Dear ______:

I am the Author of a book tentatively titled [TITLE OF BOOK] (the “Work”) that will be published by HarperCollins Publishers (“HC”) in ______.

I am writing to request permission on behalf of myself, my publisher and its licensees and assigns to use the material indicated below (the “Contribution”) in all editions and derivations of the Work (including serializations) throughout the world, in all languages and in all media, whether now known or hereinafter devised, and in the advertising, publicity and promotion of the Work.

Contribution: [Provide a detailed description of the material to be used, and attach a copy]

In order to publish the Material in the Work, we ask that you agree to comply with the following:

1. You agree that the Author of the Work or HC may edit the Contribution in the manner deemed best suited to its inclusion in the Work or any version or revised edition of the Work. Upon HC's first publication of the Work, HC shall send you one free copy of the Work which includes the Contribution. You agree to deliver the Contribution to me by ______. If you do not deliver the Contribution by the deadline, or if the Contribution is unacceptable to me or to HC, the Contribution will not appear in the Work.

2. You represent and warrant to HC that you are the sole author of the Contribution; that the Contribution is wholly original (except for such portions of it that you shall mark as having been quoted from other sources) and does not infringe upon any copyright, proprietary right, or any other right whatsoever; that the Contribution contains no matter which is libelous, in violation of any right of privacy, or otherwise contrary to law; that you are the sole and exclusive owner of the rights herein conveyed to HC; that you have not previously assigned, pledged or otherwise encumbered the same; and that you have the full power to enter into this Agreement and to make the grants herein contained. You shall indemnify the Author and HC for, and hold them harmless from, any loss, expense (including attorneys' fees) or damage occasioned by any claim, demand, suit or recovery arising out of any claim which, if sustained, would constitute a breach of any of the foregoing warranties.

3. We will credit the Contribution as follows:

(a) If the Contribution has been previously published, HC shall print the following credit in each copy of the Work published by HC:

(b) If the Contribution has not been previously published, HC agrees to copyright your Contribution in your name.

4. In consideration of the rights you are granting for the inclusion of the Contribution in all editions of the Work, the Author agrees to pay you a fee of $______upon the Author's and HC's acceptance of the complete and final Contribution for the Work. [Or: You agree that the inclusion of the Contribution in the Work is sufficient consideration for the grant of rights made herein.]

5. You agree that HC may, but is not obligated to, use your name, likeness and biographical data in connection with the publication and promotion of the Work and the exploitation of rights to the Work.

6. After HC's publication of the Work, you agree not to authorize publication of the Contribution in any book which is not solely authored by you without HC's prior written approval. You reserve the right to include the Contribution in any form you wish in a book authored solely by you.

7. This Agreement shall be binding upon and inure to the benefit of the executors, administrators, heirs and assigns of the Contributor and the Author and the benefit of the successors and assigns of HC. This Agreement shall be construed according to the laws of the State of New York.

8. Each party agrees that it is and will be an independent contractor as to the other party and not an agent, employee, partner or joint venturer of or with the other party. Without limiting the foregoing, neither party, nor any officer, director or employee of such party will have any right to bind the other party, to make any representations or warranties on behalf of the other, to accept service of process, to receive notice, or to perform any act or thing on behalf of the other party other than as expressly authorized by such other party in its sole discretion.

9. This Agreement constitutes the entire understanding of the parties relating to the use of the Contribution in the Work. hereto in relation to the subject matter hereof. No change or modification of this Agreement shall be valid unless in writing signed by the Contributor, the Author, and HC.

If you are in agreement with the foregoing, please sign both copies of this letter in the place indicated below for your signature and return them to us for countersignature.

Sincerely,

______

Contributor

Contributor's Social Security Number:______

Contributor's Birth Date:______

Contributor's Citizenship:______