Ascap Writer Application Form – Fill Out and Use This PDF

4	Complete the application processing fee payment section:
	There is a non-refundable processing fee of $75 due upon submission of your application. ASCAP will not process
	your application without payment. You may pay by credit card, check or money order. Do not send cash.
5	Send all four (4) completed and signed forms together to:
	Membership Application Enclosed, ASCAP, One Lincoln Plaza, New York, NY 10023

IF YOU HAVE BEEN A MEMBER OF OR AFFILIATED WITH ANY OTHER PERFORMING RIGHTS LICENSING ORGANIZATION, you must enclose a copy of your release from that organization with your application. This way, we can make sure our information is up to date, and be certain that other past or present affiliations will not prevent your election to ASCAP.

IN ADDITION, IN ACCORDANCE WITH PARAGRAPH 11 OF THE ASCAP MEMBERSHIP AGREEMENT, if you have granted the right to license your works for performances in foreign countries to any other entity, please provide us with a list showing each such country, the entity with which you have such an agreement, the date the agreement expires, and any other pertinent information concerning that agreement.

TAX FORM: The IRS requires that ASCAP has accurate tax information on file for all members who are U.S. citizens or resident aliens. ASCAP CANNOT PROCESS YOUR APPLICATION IF THE W-9 FORM IS NOT COMPLETED AND SIGNED. Your personal name (not a business name) and Social Security Number (SS#) must match the name and number as they appear on your Social Security card.

If you are not a U.S. citizen or resident alien, you will need to fill out a W-8BEN Form. The W-8BEN Form can be downloaded from the Internal Revenue Service’s website at: www.irs.gov. You can also request the

form by calling ASCAP’s Member Management Administration office in New York at (212) 621-6240.

ARTICLES OF ASSOCIATION, RULES AND REGULATIONS AND AFJ2: The Application asks you to acknowledge that you have read ASCAP's Articles of Association, Compendium of Rules and Regulations, and the Second Amended Final Judgment entered in U.S. v. ASCAP ("AFJ2"). All of these documents are available on our website at: www.ascap.com/reference/. ASCAP will also provide printed copies of these documents upon request at no charge.

NOTIFICATION OF ACCEPTANCE. If you are elected to membership, you will receive notice of acceptance along with your personalized ASCAP Member Card indicating your Member Code Number. A fully executed copy of your agreement will be kept on record at ASCAP.

If there is a problem with your application, ASCAP’s Member Management Administration will contact you.

THANK YOU FOR APPLYING!

H-W-ENG-2009-10

ASCAP, One Lincoln Plaza, New York, NY 10023 (212) 621-6000 WWW.ASCAP.COM

ASCAP WRITER APPLICATION

1. PLEASE PRINT OR TYPE YOUR FULL LEGAL NAME BELOW (spell out full name, do not use initials)

FirstMiddleLast IMPORTANT: If you only enter one name, you must provide legal proof of such name.

If you use a suffix with your name, (Jr., Sr., Esq., II, etc.) please include here:

1a. PLEASE LIST ANY PSEUDONYMS, STAGE NAMES OR PROFESSIONAL NAMES YOU ARE USING, IF DIFFERENT FROM YOUR LEGAL NAME.

Pseudonyms: 1.)

2.)

1b. PLEASE LIST THE NAME OF THE BAND OR MUSICAL GROUP OF WHICH YOU ARE A MEMBER (IF ANY).

Band Name:

2. DATE OF BIRTH: (mm/dd/yyyy)			/	/		(Required or your application will be returned to you)
3. CORRESPONDENCE ADDRESS:
C/O (if applicable)
Street Address							Apt. #
City	State					Zip	Country
Phone Number (	)		Fax Number (		)
E-mail*

*ASCAP will use your e-mail address for ASCAP correspondence only. We will not share or sell your e-mail address. You may opt out of receiving ASCAP e-mail correspondence or change your email address at any time, but only after you have completed the application process and have been accepted as a member.

3a. ROYALTY ADDRESS:

(only if you would like your royalties and performance statements sent to a different address than your correspondence address above)

C/O (if applicable)

Street Address			Apt. #
City	State	Zip	Country
Phone Number ( )	Fax Number (	)

4. ARE YOU A U.S. CITIZEN OR A RESIDENT ALIEN OF THE UNITED STATES?

5. SOCIAL SECURITY NUMBER: (required for U.S. citizens and residents)

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ASCAP, One Lincoln Plaza, New York, NY 10023 (212) 621-6000 WWW.ASCAP.COM

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* PLEASE ATTACH A COPY OF YOUR RELEASE FROM THIS ORGANIZATION. APPLICATIONS WITHOUT NECESSARY RELEASES CANNOT BE PROCESSED.

If affiliated as a publisher, please provide publisher’s name:

Please also provide the publisher’s Social Security Number and/or Tax ID Number: and/or Membership Code:

SUBSTANTIATING WORK INFORMATION

To qualify for membership in ASCAP, you must be the writer or co-writer of at least one musical work or song that has been commercially recorded, performed publicly in any venue or medium licensable by ASCAP, performed in any audio visual or electronic medium, or published and available for sale or rental as sheet music, a score or folio.

Please list the Title of ONE original musical work or song of which you are the writer or co-writer*:

*Entering the title of your work is solely for the purpose of substantiating your qualifications for ASCAP membership. A title registration with ASCAP for this work must be submitted upon your membership election.

Please complete AT LEAST ONE of the following requirements (A, B, C, D) you meet to qualify for membership in ASCAP and provide the information requested based on the musical work or song listed above:

Performer:

Name of Venue:

Date of Performance*:

Location (include city, state):

*The Date of Performance must be in the past. If you don’t have this qualification, you may be able to apply using another method of substantiation.

Medium:

Title or name of film, television program, website, radio station:

Date of Performance*:

*The Date of Performance must be in the past. If you don’t have this qualification, you may be able to apply using another method of substantiation.

Recording Artist:

Date of Release*:

Record Label (includes independent or self-releases):

*The Date of Release must be in the past. If you don’t have this qualification, you may be able to apply using another method of substatiation.

Title of published sheet music, score or folio:

Publisher:

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ASCAP, One Lincoln Plaza, New York, NY 10023 (212) 621-6000 WWW.ASCAP.COM

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8. Please list the type of musical genre you primarily work in (check only one):

Popular, or

Symphonic/Concert Music (works for orchestra, chamber ensemble, chorus, wind ensemble, concert band, solo instrumental, electro-acoustic forces, etc.).

9.WARRANTIES AND REPRESENTATIONS

A.I represent that there are no existing assignments or licenses, direct or indirect, of non-dramatic performing rights in or to the musical work listed in #8 above, except to or with the publisher(s) of this work. If there are assignments or licenses other than with publishers, I have attached copies of such assignments or licenses.

B.I have read the ASCAP Articles of Association, Compendium of Rules and Regulations, and Second Amended Final Judgement entered in U.S. vs ASCAP (“AFJ2”), and agree to be bound by them, as now in effect, and as they may be amended, and I agree to execute agreements in such form and for such periods as the Board of Directors shall have required and shall hereafter require for all members.

C.I represent that I meet the eligibility requirements for membership as set forth herein. I understand that ASCAP reserves the right to request substantiation of eligibility at any time.

D.I warrant and represent that all of the information furnished in this application is true. I acknowledge that any agreement entered into between ASCAP and me will be in reliance upon the representations contained in this application, and that my membership will be subject to termination if the information contained in this application is not complete and accurate.

Optional: Writer Digital Home Recording (“DART”) Royalties Election

Under the Audio Home Recording Act of 1992, royalties are paid by manufacturers and importers of digital audio recording equipment and recording media (e.g., blank tapes or discs). The royalties are shared by writers, publishers, recording artists and record companies. ASCAP can act on behalf of those members who specifically designate ASCAP to represent them in digital audio royalty matters under the Act. SEE DART FACT SHEET ON BACK FOR MORE INFORMATION BEFORE MAKING YOUR DECISION. IF YOU ARE UNDECIDED, YOU MAY LEAVE THIS SECTION BLANK.

YES, I grant the American Society of Composers, Authors and Publishers (“ASCAP”) the exclusive right to collect and distribute digital audio royalty payments as provided in Public Law No. 102-563 (the Audio Home Recording Act of 1992), as such law may be amended and payments for home recording of my copyrighted musical works outside of the United States, with respect to all of the musical works described in the ASCAP Membership Agreement.

NO, I do not wish ASCAP to represent me regarding home recording rights.

Undecided

PLEASE SIGN YOUR LEGAL NAME HERE:

Sign Here	Date
Signature of parent or guardian if applicant is under 18	Date

REMINDER: YOU MUST MAIL THE FOLLOWING FOUR (4) FORMS TOGETHER TO:

Membership Application Enclosed, ASCAP, One Lincoln Plaza, New York, NY 10023

❍ASCAP Writer Application (this form)

❍ASCAP Membership Agreement

❍W-9 Form or other applicable tax form. (See instructions.)

❍Application Processing Fee Form. (See instructions.)

ALL FOUR (4) FORMS MUST BE COMPLETED AND SIGNED OR YOUR APPLICATION WILL BE RETURNED TO YOU.

For ASCAP office use only: Card type/check #_____________________________ Transaction Code:__________________________________ Date:__________________________

H-W-ENG-2009-10

ASCAP, One Lincoln Plaza, New York, NY 10023 (212) 621-6000 WWW.ASCAP.COM

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ASCAP WRITER APPLICATION

If paying by check or money order, please make payable to ASCAP and staple or clip it here:

If paying by credit card, please complete the following information:

CARDHOLDER INFORMATION:

Cardholder Name:

Billing Address:				Apt. #:
City:		State:	Zip:	Country:
Card Type:	Visa[ ]	Mastercard[	]

Card Number:

Card ID Number (This is the last 3-digit number on the back of your credit card. See illustration below):

Expiration Date: Month______ Year______

H-W-ENG-2009-10

ASCAP, One Lincoln Plaza, New York, NY 10023 (212) 621-6000 WWW.ASCAP.COM