Licensing Agreement * = required field.

* Title:
Owner Agent Representative Publisher

* First Name:

* Last Name/Company Name:

* Phone Number:

* Address 1:

Address 2:

* City: * State:

Province: Country:

* Zip:

Email:

* Band Name(s):
One band name per line.

Check all that apply:
You or the band(s) you are representing are a registered composer with ASCAP?

You or the band(s) you are representing are a registered composer with BMI?

You or the band(s) you are representing are a registered composer with SEASAC?

You or the band(s) are representing are registered with Sound Exchange?

You or the band(s) you are representing are registered with RIAA?

You are a voting member with NARAS?

You are a member of Polka America Corporation?

I agree to waive all fees for Internet broadcasting that are normally charged via the Copyright Royalty Board and collected by Sound Exchange. I understand that this waiver only applies to Non-Commercial Educational Radio Stations, All Internet Polka Website Broadcasters(not satellite radio), Commercial Radio Stations that simulcast that have more than fifty percent polka broadcasting, or any means that is developed for broadcasting in the future that contain the previous criteria.

I Agree

Please ensure all information is accurate as you will not be able to edit your entry after using submit. If changes are needed please contact us at licensing@polkaamericacorporation.org.