Family Information
BE SURE TO PRINT OUT AND SIGN THE 2 PAGE WAIVER FORM BELOW FOR EACH
SUBMISSION
SUBMISSION GUIDELINES
(FAMILY)
1) All submissions must include author's name, address, telephone and/or e-mail on a separate
cover sheet. In addition, each submission of poetry or prose must be printed or typed legibly
on 8 �" x 11" white paper.
2) Participants may only be immediate family members of a homicide victim (e.g., spouse,
sibling, parent, children, grandchildren, grandparents or aunt/uncle).
3) Participants may submit no more than five (5) separate writings. There is no minimum word
content; however, any submission that exceeds a maximum content of 2,000 words will not be
considered for publication.
4) Participants are encouraged to speak freely about how they were impacted by the crime
of homicide and to openly express their feelings of bereavement, anger, suffering (grief),
closure, forgiveness, the need for healing, etc. Writings which are deemed non-therapeutic
or offensive in demeanor will not be considered for publication.
5) Participants may submit writings concerning how the homicide offense has impacted
themselves, the lives of their family members, the offender, the lives of the offender's family
members, the community, etc.
6) Participants will not receive any monies, payment, or reimbursement, including any royalties
from book sales for their submitted writings. However, if a writing is selected for publication,
the author's name will be used in the publication to acknowledge the credit for that writing.
Anonymous submissions will not be considered for publication.
7) The editors retain the exclusive right to use or reject any submitted writing for publication.
Authors will retain the ownership rights of their submissions, but, the Life Blossoms
publication and its copyrights are retained by its editors. Submitted writings, once received
by the Project Coordinator, will not be returned to the author.
8) If a submitted writing is selected for publication, the author will be notified via USPS mail.
Upon publishing, the selected author will receive one (1) copy of the book Life Blossoms.
Any additional copies must be purchased through the publisher or a book outlet.
9) All royalties from the sales of Life Blossoms will be donated to a non-profit charity that
promotes Victim/Offender Reconciliation Programs in homicide cases.
10) Family member participants must mail their submissions directly to:
James M. Moneymaker, Ph.D.
Siena College
c/o Life Blossoms Project
11 Dennin Drive
Menands, NY 12204-1203.
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SUBMISSION WAIVER FORM
(FAMILY)
-1-
As a participant of the Life Blossoms project and author of the attached written submission,
I agree to the following terms:
1) I am the author of the written material attached and identified below;
2) I understand that as the author, I retain the ownership rights of the attached submitted writing,
and hereby grant the editors of the Life Blossoms project the right to use and publish this
writing. Copyright ownership of the Life Blossoms publication is retained by its editors;
3) I verify that I am an immediate family member (e.g., spouse, sibling, parent, child,
grandchild, grandparent or aunt/uncle) of a homicide victim;
4) All participants must sign a Waiver Form for each submitted writing. All requested
information on the Waiver Form must be completed. A Waiver Form must be attached to
each submitted writing. I understand that all personal information (i.e., address, telephone
number, etc.) contained in the Waiver Form is confidential, and that only the Project
Coordinator will have access to this information. At no time will any prisoners or persons
not associated with this project have access to this information;
5) Participants must use their real name when submitting the Waiver Form for each writing.
Their name must not appear anywhere on the submitted article, but only on the attached
Waiver Form. Nicknames, aliases, aka's etc. which hide or conceal the identity of the author
will result in their submission not being considered for publication;
6) I understand that I will not receive any monies, payment, or reimbursement, including any
royalties from the Life Blossoms book sales as a result of submitting this material for
publication purposes;
7) The editors are authorized to use my real name in the Life Blossoms publication and I will
be given a honorary written credit if my material is published;
8) Whereupon my written material is published in the book Life Blossoms, the editors and/or
publisher will send me one (1) copy of the Life Blossoms book;
9) I understand that any failure on my part to complete this Waiver Form may result in my
material not being considered for publication;
The undersigned agrees to the above terms and affirms that the information contained in this Waiver Form is truthful:
___________________________________ _____________________________
Author's signature Date
___________________________________ _____________________________
Please print or type full name of Author Author's telephone #
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WAIVER FORM
(FAMILY)
-2-
______________________________
______________________________
______________________________ ____________________________________
Author's full address Author's e-mail address (if applicable)
Title of attached submitted writing: __________________________________________________
______________________________________________________________________________
______________________________________________________________________________
1) Name of deceased family member:________________________________________________
2) Author's relation to deceased: ___________________________________________________
3) Age of deceased at time of death: ________________________________________________
4) Date deceased passed away: ___________________________________________________
5) Was the offender convicted? __Yes __ No (check one)
6) If yes to Question #5, what was the offender sentenced to?:____________________________
________________________________________________________________________
7) Is the offender eligible for parole? __Yes __No __Unknown (check one)
8) Describe your personal feelings toward the offender:__________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
*May the editors contact you for any further information? __Yes __No (check one)
Note: Please be certain to attach this 2-page Waiver Form to each submitted writing.
Make photocopies if necessary. Those who have access to the Internet may download
extra copies from our website: http://www.geocities.com/life_blossoms_info/