Instructions: After completing Part I, forward this form by e-mail (by clicking "send") to the publisher who will complete the form and return it to you. This return copy will either give permission, deny permission, or ask for payment. If the publisher indicates a payment for the right you request, and if the conditions are agreeable to you, remit the amount to the publisher together with a copy of the agreement, whereupon the agreement will be completed and a copy of the permission will be sent to you.

Part I

To: Alfred Publishing Company A-R Editions Arsis Press Baerenreiter Belwin-Mills Black Squirrel Music Boelke-Bomart Boosey and Hawkes Brichtmark Music Carl Fischer Cherry Lane Edward B. Marks Music Company FJH Music Company G. Henle USA, Inc. Hal Leonard Corporation Jerona Music Corporation Kendor Music Company Manduca Music Publications Mobart Music Mona Lisa Sound Music Associates of New York Music Sales/G.Schirmer Music Together Neil A. Kjos Music Company Piedmont Music Company Pocono Mountain Music Publishing Puna Music Company Trillenium Music Company Universal Edition Warner Brothers Publications

I (We) wish to photocopy copies of your copyrighted publication, which we have been unable to locate in print:

[title]
[arrangement]
by:

1. We will produce these copies of for use and performance only by our teachers, students, members, congregation.
2. No right to record or to reproduce additional copies is granted to us. We understand that if we wish to record the work a separate license will be required.

[name of institution]
[address]
[e-mail address]
By: