Song Writers Publishing Application

Are you a U.S. Citizen or Alien Resident?

Please select

Are you 18 years old?

Do you have a Valid U.S. Social Security Number?

Social Security Number

Full Name

PrefixFirst NameMiddle NameLast Name

Birth Date

MonthDayYear

Phone Number

Area CodePhone Number

Country of Citizenship

List Stage Name or Professional Name (if any)

List Band or Group Name (if any)

Complete Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

E-mail

Confirm E-mail

I am currently or have been a(n)

Are you a member of a Foreign Performing Rights Society?

Have you assigned or licensed the performing right in your musical work?

Will you be self-publishing your work?

If yes, please also complete the Publsiher's application

Has your work been

I am applying as a

Music Genre

Title of ONE song you wrote or co-wrote

You MUST complete AT LEAST ONE of the following requirements (A, B, C, D) to you meet and to qualify for membership in a Performing Rights Society. Provide the information requested based on the musical work or song listed above:

A. If this is a commercial recording, such as a CD, Give Name of Recording Artist

Name of Record Label

Date of Release

MonthDayYear

OR

B. If this is a Public Performance, Give Name of Performer

Venue of Performance

City and State of Venue

Date of Performance

MonthDayYear

OR

C. If your music was on TV, Radio, Film, Cable, internet or pay-per-view, list which one

Name of TV show, film, website, radio program

Date of performance

MonthDayYear

OR

D. If this is published sheet music, a score or folio that is for sale or rental, give Title

Give name of Publisher

WARRANTIES AND REPRESENTATIONS

A. I represent that there are no existing assignments or licenses, direct or indirect, of non-dramatic performing rights in or to the musical work listed above, except to or with the publisher(s) of this work.

If there are assignments or licenses other than with publishers, I have attached copies of such assignments or licenses.

B. I represent that I meet the eligibility requirements for Performing Rights Societies' membership as set forth in their articles

I understand that the Performing Rights Societies reserves the right to request substantiation of my eligibility at any time.

C. I warrant and represent that all of the information furnished in this application is true.

D. I acknowledge that any agreement entered into between me and the Perforrming Rights Societies will be in reliance upon the representations contained in this application, and that my membership will be subject to termination if the information contained in this application is not complete and accurate.

E. I further hold Many Moods Productions, its affiliates, employees and or subsidaries, harmless from any action or lawsuit bought against me or initiated by me due to inaccurate or false information and/or representation that may be contained in my application.

I have read and agree to the above statement

If you have ever been or are currently a member of ASCAP/BMI/SESAC or a Foreign PRO, upload your release form here

Upload a File

Today's Date

MonthDayYear

Set up my Publishing

ASCAP Songwriter$129.00

BMI Songwriter$145.00

Total $0.00

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Songwriter's Publishing Application

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