Name*

State*

Email*

Type of Talent* (can select multiple choices)
 Vocal Dance/Movement to Music Instrument Monologue

If you selected "Dance/Movement to Music," please describe the style (ie lyrical, contemporary, Irish, etc)

If you selected "Instrument," please enter which one

IF USING MUSIC

Name of Song

Name(s) of Writer/Composer

Year Copyrighted/Released

When you looked up the song on www.ASCAP.com/repertory, was the writer/composer covered by ASCAP, BMI and/or SESAC?
---YesNoUnsure

IF USING RECORDED MUSIC

Name of Song

Name(s) of Performer(s)

Name of Album

When you looked up the song on www.ASCAP.com/repertory, was the performer covered by ASCAP, BMI and/or SESAC?
---YesNoUnsure

IF USING A SPOKEN PIECE

Name of Piece

Name(s) of Writer(s)

Who holds the rights to the piece? (i.e. publisher, agent, artist, etc. - should be listed in the credits of the work)

Have you filled out the form letter and mailed it to the publisher/rights holder?
---YesNo

If you have, please attach a copy of the letter. (.docx or pdf)

Also, have you heard back?
---YesNo