American Camellia SocietyPermission for Cultivar Registration Named for a

Specific PersonA new cultivar may be named for a person other than yourself. The American Camellia Society requires written authorization from the person for whom the new cultivar shall be named or from such person's agent. The ACS will accept written authorization from the following persons: (i) the person for whom the new cultivar shall be named, if such person is still living; (ii) the personal representative of the estate for which the new cultivar shall be named, if such person is deceased; or (iii) the legal guardian of the person for which the new cultivar shall be named if such person is currently a minor or is incompetent. Such person granting permission to the ACS shall indicate their name and the capacity in which they are signing below where indicated. Please fill out the information below and have the granting person or agent sign in the space below. Send the information to the ACS at the below address. Thank you.

Date:

I grant permission to have the camellia named for me.

Typed/Printed Name of Person Granting Permission:

Title of Agent Granting Permission: (If not person for whom camellia is named)

Signature of Person Granting Permission:

American Camellia SocietyAttn: William Khoury100 Massee LaneFort Valley, GA 31030

Thank you.