Synchronization License Application

Use this form to obtain permission to include
one of our editions on a DVD, Film or Video.

Please be sure to fill in all of the fields.

	Date
	Title of the work you would like to use.
	Composer of Music
	Author of Text (if any)
	Exact duration of performance
	Format of Recording (Video, Film, DVD, etc.)
	No. of copies to be manufactured
	Country of Manufacture
	In what countries will they be distributed (Name of countries or Worldwide)
	Production Company (Label)
	Name and Title of Person Responsible for Execution of this License
	Full Street Address
	Telephone No.
	Fax No.
	Web Site
	E-mail Address

Date