AGEHR Music - Mechanical/Synchronization License Information
Please do not complete this form unless you have already purchased your Mechanical or Synchronization License in our On-Line Store. A Mechanical License is required prior to making an audio recording of a performance of any AGEHR Music publication. The license fee is $10.00 minimum for up to 118 CD copies. After that, the charge is $0.091 per song, per CD.
A Synchronization License is required to making an audiovisual recording of any AGEHR Music publication. The license fee is $0.15 per title per copy.
First Name *
Last Name *
Company Name
Street *
City *
State *	ALABAMA ALASKA ARIZONA ARKANSAS CALIFORNIA COLORADO CONNECTICUT DELAWARE DISTRICT OF COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON PENNSYLVANIA RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING AMERICAN SAMOA FEDERATED STATES OF MICRONESIA GUAM MARSHALL ISLANDS NORTHERN MARIANA ISLANDS PALAU PUERTO RICO U.S. MINOR OUTLYING ISLANDS ARMED FORCES AMERICAS ARMED FORCES ARMED FORCES PACIFIC ALBERTA BRITISH COLUMBIA MANITOBA NEW BRUNSWICK NEWFOUNDLAND NOVA SCOTIA NORTHWEST TERR. NUNAVUT ONTARIO PRINCE EDWARD ISLAND QUEBEC SASKATCHEWAN YUKON
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Phone *
Fax
Email *
Did you purchase a Mechanical License (audio recording only) or a Synchronization License (video with audio recording)? * Mechanical License Synchronization License
Title of Piece *
Composer/Arranger *
AGEHR Music Catalog # *
Length of Piece (minutes) *
Type of Media *	CD Audio Tape MP3 DVD Television Production Commercial Performance Other
If other, describe:
No. Units Produced *
Air Date/Release Date *
Intended Use *
If you are recording more than one title, please complete this form for each title you are recording.

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