Release Form

I hereby grant permission to GaryDickson.com to use my poetry on its World Wide Web site without further consideration. I also acknowledge that GaryDickson.com may choose not to use my poem(s) at this time, but may do so at its own discretion at a later date.

I also understand that once my writings are posted on GaryDickson.com's website, they can be downloaded by any computer user. Therefore, I agree to indemnify and hold harmless from any claims the following:

Gary Dickson
GaryDickson.com
KDKA Radio
CBS/Infinity Broadcasting
All employees of KDKA Radio

I certify that the included writings are that of the person indicated below. GaryDickson.com reserves the right to discontinue use of these writings without notice.



FULL NAME: _____________________________________________________


NAME OR NICKNAME
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DATE: ______________________________________


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Mail to: Gary Dickson, KDKA Radio, One Gateway Center, Pittsburgh, PA 15222