SYNCH REQUEST FORM

TO: Suzanne Carey Phone: 020 7835 5377 Email: suzanne.carey@umusic.com abi.bunce@hotmail.com

FROM (insert your contact details): DATE REQUESTED:

05/09/12 Let You Go Chase and Status

TITLE OF COMPOSITION: COMPOSER(S): % PUBLISHER CONTROLS: PRODUCTION NAME: COMPANY/CLIENT NAME AND ADDRESS: PRODUCTION CO. AND ADDRESS (If Different):
STATE WHO THE LICENCE & INVOICE SHOULD BE ISSUED TO:

A2 Advanced portfolio Abi Bunce Marlborough School, Shipton Road, Woodstock, Ox20 1LP

Abigail Bunce A-Level Media Studies Course

PURPOSE OF PRODUCTION:

SCENE DESCRIPTION OF MUSIC USE (Visuals): DURATION OF MUSIC USE: MEDIA TYPE (e.g.. DVD, Online etc): NUMBER OF COPIES: URL: PURPOSE OF SITE:

Exam use only 10 months (to create it) DVD 1 http://abibunceblog.blogspot.co.uk/ Educational

HOW IS THE PRODUCTION TO BE USED ON SITE (e.g. popup/banner/homepage):

Video

TERRITORY (e.g. U.K): WHERE IS THE PRODUCT GOING TO BE SHOWN: Internal/External to the school LICENCE TERM: LICENCE START DATE:

UK Internal and External (examiners)

January 2013 till on blog

PLEASE STATE ANY OTHER SONGS BEING USED IN THE PRODUCTION: OTHER INFORMATION: Please note that you MUST contact the MCPS-PRS Alliance for a performance licence on all online uses on 0207 580 5544 EDUCATIONAL FEE: TBC (Subject to management's approval) Please note: This quote is valid for 30 days from the date of this application

Please note that any fees quoted by UMPG will be for publishing clearance only, master rights must be cleared and quoted separately.

N.B. Internet use will only be approved where appropriate streaming technology is put in place to ensure that the commercial cannot be copied, downloaded & saved, transferred or manipulated in any manner whatsoever.