Music Rental Order Form

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Dylan Fixmer

To request a rental for an orchestral piece, wind piece or opera, please fill out the form below.

Performance Organization

Name of Performing Group

ASCAP License Number

Contact Name

First Name

Last Name

Phone

(###)

###

####

Performance Organization Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Title of Requested Work

Materials and Quantity Requested Including String Count Requirements

(One standard set consists of two scores, and one set of parts)

Number of Performances

Date(s) of Performance(s)

Performance(s) Venue(s)

Conductor

Soloist

Required Date of Receipt of Materials

Please input this date in specified format. Signed agreement must be returned no later than 10 (ten) business days before this date to avoid rush fees.

YYYY

Annual Budget of Organization

To provide a fair sliding scale fee for the work.

Performance Type

Check all that apply

Live Concert Performance

Live Streamed Concert

Live Radio Broadcast

Live Television Broadcast

Performance with Choreography

Audio-Only Commercial Recording

Educational/Outreach Performance

Other (Please specify in comments)

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