Form to Request Copyright Permission - Cuts from CD's/SLP's

See instructions for filling out copyright request forms


Instructor:
 Course #:

I am requesting (choose one):
synchronization rights      mechanical licensing rights

Title of composition:

Composers [please include first and last name(s)]:

Date published:

Publisher of composition:

Performer(s) of composition [please include first and last name(s)]:

Title of LP/CD:

Publisher of LP/CD:

Date of LP/CD publication:

Length of excerpt to be copied (in minutes and seconds):

Length of original recording:

Time sequence of recording:

Purpose of project:

Number of copies of project:
  		 Will copies be distributed or retained by instructor?:

If distributed, what is the mode of distribution?:

Countries of distribution:

Mode of instruction:

Length of time the contract needs to cover:

Only fill out the following if you are requesting mechanical licensing rights:

Format to be used (e.g. tapes, CD's):

If you would like a copy of this form enter e-mail address: