Licensing Registration

Please enter your information in the applicable fields. A * indicates a required field. If registrations submitted do not contain verifiable information or contains inaccurate information, those submissions will not be included in the repertoire.

Licensing Registration

Title*OwnerAgentRepresentativePublisher

First Name*

Last Name/Company Name*

Phone Number*

Address 1*

Address 2

City*

State

Province

Country

Zip*

Email Address

Band Names (seperate by a comma)*

Check If ApplicableYou or the band(s) you are representing are a registered composer with ASCAP

Check If ApplicableYou or the band(s) you are representing are a registered composer with BMI

Check if applicableYou or the band(s) you are representing are a registered composer with SEASAC

Check if applicableYou or the band(s) you are representing are registered with Sound Exchange

Check if applicableYou or the band(s) you are representing are registered with RIAA

I agree to the following

Please ensure all information is accurate before submitting. You may contact us with questions at licensing@polkaamericacorporation.org