BOX5 Copyright Compliance Form
BE SURE TO ANSWER ALL QUESTIONS FULLY.
School / Director Information
School Name?
Your answer
Director Name?
Your answer
Director Email Address
Your answer
Which BOX5 event is your group attending?
Band Booster President Name?
This information will help BOX5 market our video products directly to your organization without the need to market through the directors.
Your answer
Band 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.
Your answer
COPYRIGHT 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 Compositions Used in Show
COMPOSITION #1
Composition #1 Name
*please use actual name of the composition, NOT the name of your arranged movement, etc.
Your answer
Composition #1 Composer
If composer unknown, please supply name of performing artist (Example: The Beatles)
Your answer
Composition #1 Arranger
Your answer
Composition #1 Composer / Arranger Email
Your answer
Do you have copyright clearance for Composition #1?
If yes, you can upload the form here or mail/fax license to BOX5 Media
COMPOSITION #2
Composition #2 Name
*please use actual name of the composition, NOT the name of your arranged movement, etc.
Your answer
Composition #2 Composer
If composer unknown, please supply name of performing artist (Example: The Beatles)
Your answer
Composition #2 Arranger
Your answer
Composition #2 Composer / Arranger Email
Your answer
Do you have copyright clearance for Composition #2?
If yes, you can upload the form here or mail/fax license to BOX5 Media
COMPOSITION #3
Composition #3 Name
*please use actual name of the composition, NOT the name of your arranged movement, etc.
Your answer
Composition #3 Composer
If composer unknown, please supply name of performing artist (Example: The Beatles)
Your answer
Composition #3 Arranger
Your answer
Composition #3 Composer / Arranger Email
Your answer
Do you have copyright clearance for Composition #3?
If yes, you can upload the form here or mail/fax license to BOX5 Media
COMPOSITION #4
Composition #4 Name
*please use actual name of the composition, NOT the name of your arranged movement, etc.
Your answer
Composition #4 Composer
If composer unknown, please supply name of performing artist (Example: The Beatles)
Your answer
Composition #4 Arranger
Your answer
Composition #4 Composer / Arranger Email
Your answer
Do you have copyright clearance for Composition #4?
If yes, you can upload the form here or mail/fax license to BOX5 Media
Additional Information / Comments
Your answer
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 band director signing this form
Type your full name
Your answer
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