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I am writing to ask for permission to upload this image to Wikimedia Commons:

http://sourceforge.net/dbimage.php?id=265406

To permissions-commonswikimedia.org
I hereby assert that I am the creator and/or sole owner of the exclusive copyright of WORK [ insert link ].
I agree to publish that work under the free license LICENSE [ choose at least one from this page: http://commons.wikimedia.org/wiki/Commons:Choosing_a_license#Common_free_licenses — THIS DECLARATION IS NOT VALID UNLESS YOU FILL SOMETHING IN 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, as long as they abide by the terms of the license and any other applicable laws.
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 am aware that the free license only concerns copyright, and I reserve the option to take action against anyone who uses this work in a libelous way, or in violation of personality rights, trademark restrictions, etc.
I acknowledge that I cannot withdraw this agreement, and that the work may or may not be kept permanently on a Wikimedia project.
 DATE OF TODAY, NAME OF THE COPYRIGHT HOLDER

Do I have your permission to use the media file?

Yours faithfully

Christopher Forster