Form Instructions

Music (Master Use) License-Performer for Voice/Music 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 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 5, 2012.

Please make sure all of your TVA materials are completed.

1. Fill in your team leader’s name, sponsoring school, and video title.
2. Check whether the musical performance used in your video is royalty-free, performed yourself, or used with permission.
3. If the performance is royalty-free, fill in the address of the website that indicates that the performance is royalty-free. Fill in the title of the composition and the name of the performer.
4. If you perform the piece yourself, fill in the title of the composition.
5. If the performance is used with permission, fill in the title of the composition and name of the performer.
6. The team leader must sign and date this section.
7. For performances that are performed yourself or used with permission, the performer 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 performer is under age 18 as of March 5, 2012, the performer’s parent or legal guardian must fill in their own name, sign their name, and date the form.