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
Please complete and print this form. Submit it with all of your TVA materials
according to the contest rules.
Submission deadline is 4 p.m. on March 4, 2013.
Please make sure all of your TVA materials are completed.
- Fill in your team leader’s name, sponsoring school, and video title.
- Check whether the music used in your video is royalty-free, composed yourself, or
used with permission.
- If the music is royalty-free, fill in the address of the website that indicates
that the music is royalty-free. Fill in the title of the composition and the composer.
- If you composed the music yourself, fill in the title of the composition.
- If the music is used with permission, fill in the title of the composition and the
- The team leader must sign and date this section.
- 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.
- If the composer is under age 18 as of March 4, 2013, the composer’s parent or legal
guardian must fill in their own name, sign their name, and date the form.