BOX5 Copyright Compliance Form
BE SURE TO ANSWER ALL QUESTIONS FULLY.
School / Director Information
School Name? *
Director Name? *
Director Email Address *
Which BOX5 event is your group attending? *
Booster President Name?
This information will help BOX5 market our video products directly to your organization without the need to market through the directors.
Booster President Email Address?
This information will help BOX5 market our video products directly to your organization without the need to market through the directors.
MUSIC INFORMATION BELOW
Fill out all information completely. If you have more than 4 compositions in your show, please fill out this form again and as many times as needed.
Number of Musical Selections Used in Show *
MUSIC / SONG / COMPOSITION #1
MUSIC / SONG / COMPOSITION #1 Name *
*please use actual name of the composition, NOT the name of your arranged movement, etc.
MUSIC / SONG / COMPOSITION #1 Composer
If composer unknown, please supply name of performing artist (Example: The Beatles)
MUSIC / SONG / COMPOSITION #1 Arranger
MUSIC / SONG / COMPOSITION #1 Composer / Arranger Email If Available
Do you have copyright clearance for Song #1?
If yes, you can upload the form here or mail/fax license to BOX5 Media
Clear selection
MUSIC / SONG / COMPOSITION #2
MUSIC / SONG / COMPOSITION #2 Name
*please use actual name of the composition, NOT the name of your arranged movement, etc.
Composer - MUSIC / SONG / COMPOSITION #2
If composer unknown, please supply name of performing artist (Example: The Beatles)
Arranger - MUSIC / SONG / COMPOSITION #2
Composer / Arranger Email of - MUSIC / SONG / COMPOSITION #2
Do you have copyright clearance for song #2?
If yes, you can upload the form here or mail/fax license to BOX5 Media
Clear selection
MUSIC / SONG / COMPOSITION #3
Name - MUSIC / SONG / COMPOSITION #3
*please use actual name of the composition, NOT the name of your arranged movement, etc.
Composer - MUSIC / SONG / COMPOSITION #3
If composer unknown, please supply name of performing artist (Example: The Beatles)
Arranger - MUSIC / SONG / COMPOSITION #3
Composer / Arranger Email if available of MUSIC / SONG / COMPOSITION #3
Do you have copyright clearance for Song #3?
If yes, you can upload the form here or mail/fax license to BOX5 Media
Clear selection
MUSIC / SONG / COMPOSITION #4
Name - MUSIC / SONG / COMPOSITION #4
*please use actual name of the composition, NOT the name of your arranged movement, etc.
Composer - MUSIC / SONG / COMPOSITION #4
If composer unknown, please supply name of performing artist (Example: The Beatles)
Arranger - MUSIC / SONG / COMPOSITION #4
Composer / Arranger Email if available of MUSIC / SONG / COMPOSITION #4
Do you have copyright clearance for Song #4?
If yes, you can upload the form here or mail/fax license to BOX5 Media
Clear selection
Additional Information / Comments
Electronic Signature Agreement
By selecting the "I Accept" box, I confirm that I am the band director identified at the top of this form and I am signing this Copyright Service Form electronically. I agree my electronic signature is the legal equivalent of my manual signature on this form. By selecting "I Accept" I acknowledge that the information provided in this form is true, accurate and complete and that I am submitting on behalf of myself as an authorized representative of my band, my school and its administration. By selecting the “I Accept” button I understand and acknowledge that my school and I am bound by intellectual property laws and subject to applicable penalties for violation of civil and criminal law.
By checking this box you are giving your digital signature that you agree to our terms and conditions above *
Name of director signing this form *
Type your full name
Submit
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