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Form Instructions

Music (Synch) License-Composer Form

For the HMSA Teen Video Awards Contest, students, working individually or in teams, compete to create and produce the best public service announcements on a teen health issue.

Please print and complete this form. Submit it with all of your TVA materials according to the contest rules. Submission deadline is 4 p.m. on March 3, 2008.

Please make sure all of your TVA materials are completed.

1. Write in your team leader’s name, sponsoring school, and video title.
2. Check whether the music used in your video is royalty-free, composed yourself, or used with permission.
3. If the music is royalty-free, fill in the address of the web site that indicates that the music is royalty-free. Fill in the title of the composition and the composer.
4. If you composed the music yourself, fill in the title of the composition.
5. If the music is used with permission, fill in the title of the composition and the composer.
6. The team leader must fill in their name and sign and date this section.
7. For music that you composed yourself or used with permission, the composer must fill in the name of the composition, read the conditions of the agreement, and fill in their name and date, sign the form, and fill in their complete address.
8. If the composer is under age 18 as of March 3, 2008, the composer’s parent or legal guardian must fill in their own name, sign their name, and date the form.