User:CrazyLegsKC/License permission form

I, [INSERT NAME], hereby assert that I am the creator and/or sole owner of the exclusive copyright of the image located at [INSERT URL HERE].

I agree to publish that work under the following free license: [INSERT LICENSE NAME HERE].

I acknowledge that I grant anyone the right to use the work in a commercial product, and to modify it according to their needs.

I am aware that I always retain copyright of my work, and retain the right to be attributed in accordance with the license chosen. Modifications others make to the work will not be attributed to me.

I acknowledge that I cannot withdraw this agreement, and that the image may or may not be kept permanently on a Wikimedia project.

Signed,
[INSERT NAME]
[INSERT DATE]