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AGEHR Handbell Music Licensing for CDs or Video Recording

Synchronization License Form

Please mail or fax this form to:

AGEHR Synchronization License
1055 E. Centerville Station Rd.
Centerville, OH 45459
Tel: 937-438-0085
Fax: 937-438-0434
Email: assistant@agehr.org

Date:
Production Company Name/Licensee:
Contact Name:
Address:
 
City:
State:   Zip Code:
Phone:
Fax:
Email:
  Title Writer(s) (Arranger if applicable)
     1)
     2)
     3)
     4)
     5)
Type of Media
(Performance/Television/
Commercial/DVD/Video):
Number of Units to be Produced (DVD/Video):
Type of Use/Duration:
Air Date/Release Date:
Term:
Territory:
Please give a brief description of use, below:
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