TITLE: ________________________________________.

FORM OF MATERIAL: __________________________.

DATE:_____________________.

PRINCIPAL CHARACTERS:

_______________________________________________________________.

BRIEF SUMMARY OF THEME OR PLOT:

____________________________________________________________

____________________________________________________________

____________________________________________________________

____________________________________________________________.

WGA REGISTRATION NO.: _______________. NO. OF PAGES: ______.

1. I request that you read and evaluate said material.

2. I warrant that I am the sole owner and author of said material, that I have the exclusive right and authority to submit the same to you upon the terms and conditions stated herein; and that all of the important features of said material are summarized herein. I will indemnify you of and from any and all claims, loss or liability that may be asserted against you or incurred by you, at any time, in connection with said material, or any use thereof.

3. I agree that nothing in this agreement nor the fact of my submission of said material to you shall be deemed to place you in any different positions than anyone else to whom I have not submitted said material.

4. I understand that as a general rule you consider literary properties through the established channels in the industry. I recognize that you have access to and/or may create or have created literary materials and ideas which may be similar or identical to said material in theme, idea, plot, format, or other respects. I agree that I will not be entitled to any compensation because of the use by you of such similar or identical material which may have been independently created by you or have come to you from any other independent source. I understand that no confidential relationship is established by my submitting the material to you hereunder.

5. I have retained at least one copy of said material, and I hereby release you of and from any and all liability for loss of, or damage to, the copies of said material submitted to you hereunder.

6. I enter into this agreement with the express understanding that you agree to read and evaluate said material in express reliance upon this agreement and my covenants, representatives and warranties contained herein, and that in the absence of such an agreement, you would not read and evaluate said material.

7. I hereby state that I have read and understand this agreement and that no oral representatives of any kind have been made to me, and that this agreement states our entire understanding with reference to the subject matter hereof.

Very truly yours,

____________________________________.

Signature

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Address, City and State

Print Name

___________________________________.

Telephone Number:

SS#: