I am writing on behalf of a professor/student at Arizona State University. We are asking your permission to use work in public performance. This selection is from . This will be used in a Dance Concert sponsored by the University's Department of Dance. The presentation will be at the University's Dance Theater, maximum capacity is 281 persons. The dance for which this music may be used is entitled . The audience will comprise mostly of university students. Ticket prices range from .

The choreographer of this dance will / will not (check one) alter or edit this musical selection. If necessary, please contact the composer and request his or her Grand Rights for choreography to be set to the aforementioned piece of music. The performance will be videotaped for documentation and archival purposes only. It will not be used for commercial purposes.

The performances are integral components to each undergraduate and graduate student's educational growth and development as choreographers and performers. Proceeds go back into the Department's general funds or are used for student financial support. Technical staff is on salary and does not get paid per production.

If you do not solely control copyright for the requested materials, I would appreciate any information you can provide about others to whom I should write, including contact information, preferably a fax number. If we need to gain permissions for mechanical rights from the recording company for this selection, please indicate so by checking this box: .

If you would like us to include a program note for this production indicating that this piece of music is being used with kind permission from your company, please inform us of this request at least two weeks before the aformentioned presentation date.

Submitted by:

Jennifer Armstrong
Program Coordinator
Department of Dance
(480) 965-1208

Please sign below and send by return fax to: Department of Dance (480) 965-2247

I hereby represent that I have authority to grant the permission requested above, and I do hereby grant that permission. I am the sole owner/author of the work (or I am aware of the following other owners/authors of the work):

PUBLISHER:
Printed Name:

Signature: ____________________________

Date:

COMPOSER:
Printed Name:

Signature: __________________________

Date: