To the venue manager or promoter

Please complete this form and ensure that you or one of your staff must sign the declaration at the end of the form.

Thank you for your help. It is only by collecting this sort of information that JACAP can pay out royalties accurately.

Completing this form does not make you a member of JACAP. To find out more about joining JACAP, please call 927-7265.

The Venue

The Promoter

DECLARATON:

My checking the box, I confirm that, to the best of my knowledge, the details on the form are correct.

List of titles performed

If more than 20 works are performed, please continue on separate form.

Item 1

Item 2

Item 3

Item 4

Item 5

Item 6

Item 7

Item 8

Item 9

Item 10