BMI Work Registration Form

work Registration FormBroadcast Music, Inc., 10 Music Square East, Nashville, TN 37203 Attn. Music Works Registration Dept. 615-401-2000 COMPLETE form IN ACCORDANCE WITH INSTRUCTIONS ON THE REVERSE SIDE AND RETURN TO NOT USE THIS form TO CORRECT OR REVISE INFORMATION ON A PREVIOUSLY REGISTEREDWORK. PLEASE SUBMIT WRITTEN REQUESTS FOR UPDATES ON PREVIOUSLY REGISTERED WORKS TOTHE BMI MUSIC WORKS Registration - ONE work PER FORMAKAIF BASED ON PUBLIC DOMAIN - ENTER ORIGINAL TITLE, WRITER AND SOURCETYPE OR PRINT NAME AND ADDRESS OF SUBMITTING BMI AFFILIATEWRITER(S) NAME(S)LASTFIRSTMIDDLEWRITER(S) ADDRESSAFFILIATION ( , ASCAP,SESAC, PRS)WriterPercentageShareFOR BMI USEDO NOT WRITE BELOWqCHECK HERE IF NO RIGHTS GRANTED BY WRITER(S) TO ANY PUBLISHERqCHECK HERE IF PUBLISHER IS ADMINISTRATOR ONLY.

Work Registration Form Broadcast Music, Inc., 10 Music Square East, Nashville, TN 37203 Attn. Music Works Registration Dept. 615-401-2000 COMPLETE FORM INACCORDANCE WITH INSTRUCTIONS ON THE REVERSE SIDEAND RETURN TO BMI.

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