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REQUEST FOR PERMISSION TO ARRANGE

PART 1:   INSTRUCTIONS

This form is to be prepared in duplicate.  After completing PART 1 and signing both copies where indicated, 
forward both to the publisher who will complete PART 2 of the form and return it to you.  
If the publisher indicates a payment for the permission you request, and if  the conditions are agreeable to you, 
remit the amount to the publisher together with the original copy, which they will have signed, where-upon the 
agreement will be completed.

To:____________________________________________  Date: _______________

         (Name of Publisher)

Address:______________________________________________________________

             ______________________________________________________________

Publisher:

We hereby request your permission and non-exclusive license to arrange the following musical composition.

___________________________________________________________

By:_________________________________ (words) ______________________________(music)

(hereinafter referred to as "The Arrangement")

1.  The Arrangement will be for _________________________________________

                                                         (Type of arrangement)

in __________________________________________________________________

         (Number of instrumental and/or vocal parts)

We will produce _______________ copies of the Arrangement for use and

performance only by our _____________________________________________

                                 (Teachers, students, members etc.)

2.  No right to record or to reproduce additional copies is granted to us. We understand that if we wish to record 
The Arrangement a separate  license will be required.  We agree not to distribute (except for use of copies as 
provided in Paragraph 1), sell, loan or lease copies of The Arrangement to anyone.

PART 2

3.  All copies of The Arrangement shall bear the following copyright notice and the words "arranged by permission" 
at the bottom of the first page of music of each part of The Arrangement.  We will furnish you with a  copy of 
The Arrangement upon completion.

(Copyright notice)____________________________________________________

 ______________________________________________________________________


4..  We will have The Arrangement made by a person connected with us as our employee for hire, without any 
payment obligation on your part, and on our signature below, together with yours underneath the words 
"Permission Granted" below shall assign to you all of our right in The Arrangement and the copyright in 
The Arrangement together with the sole right of registering the copyright as a work made for hire in your name 
or the name of your designee.

5.  Additional provisions (if applicable):

6.  In consideration of your permission to arrange, we will pay you $_________
upon the granting by you of the permission requested.

7.  The license agreement sets forth our entire understanding and may not be modified or amended except by 
written agreement signed by both of us.

Very truly yours,

______________________________________

(Name of institution)

 ______________________________________

(Address)

 ______________________________________

By: __________________________________

PERMISSION GRANTED:

By:_______________________________________


PERMISSION DENIED BECAUSE:

____ Arrangement available for sale.

____ Arrangement in process of publication.

____ May not be arranged because of contractual commitments.

____ Other: _____________________________________________________________________


 ____________________________________________________________________________