Simple Dance Edit | cheMIXtry

Who is filling out this form? *

Team/School Name *

This name will appear on music licenses as "team/school".

Representative Name *

First

Last

This name will appear on music licenses as "representative". This name MUST be the person who will be presenting paperwork.

Representative Email *

Email

Confirm Email

School/Organization Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

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