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. <br /> . , , <br /> � <� <br /> AGREEMENT � '� • <br /> THIS AGREEMENT made and entered into on (oarewinbeenrerodbyen.f�uponexecunon) � <br /> between BROADCAST MUSIC, INC., a corporation organized under the laws of the State of New Yorlc(hereinafter called <br /> BMI) with principal offices located at 320 West 57n'Street, New York, N.Y. 10019, and <br /> � . <br /> OFFICE ADDRESS <br /> ENTER LEGAL NAME �Ql'i��ll 1� tIYJ I C i �i G� C�t17 /��� ` L�� �}� � �,��CGC�y Y' <br /> (Nams of corporation,parmarship,or indrvidual e� (StfeSt Addr9SS) <br /> �� Gd ry ���—°�'j,� �/Q2�2 �L- ��J�j? <br /> (c;ryl (srare) Zvl <br /> ENTER TRADE NAME��� UY/G�///�/�l�7�LI/� I .� — / <br /> (DanA business under the name o���p (Te eph e No.) ' ax Number) <br /> �, r --�' <br /> /��yi �r�r��� �lI'a a � ���c > � <br /> (Contact Name) �tl � <br /> CHECK APPROPRIATE BOX AND COMPLETE MAILING ADDRESS(if different) I <br /> � individual Ownership (�>�Ty f� ��C?C,Q�v r"' <br /> (Sheet ddress) <br /> � LLC �rporation ��/!!0� `��1��/-O�� �j / C'GL!' �J''S'o�� (D r�j�� <br /> U (scace ofincorporatlon) ( iryJ (starel 2P1 <br /> � LLP � Partnership `a 17� �Z Z 9,�E, $ , <br /> (Enter names of partners) (Te/ephone No.) (Fax Number) <br /> � Other Fed.Tax ID# 7oh7 �� r r�e I/ i�%lG�./S� � <br /> (Cartact Name) (1�ide) <br /> To Be Completed by UCENSEE <br /> By slgning this Agreement you agree that the foregoing is a <br /> true and accurate representation of your Music Policy. To Be Completed by BMI I <br /> Broadcast Music,Inc. <br /> i have read and have understood ail of the terms and conditions <br /> herei d my signature below is evidence of this. , <br /> _---- � Signature Signature I <br /> �� �rr� �.)J a �r e , !, <br /> Pint Name/TiUe Print Name/TiUe !I <br /> PLEASE RETURN THIS ENTIRE SIGNED AGREEMENT WITH YOdR CHECK TO I <br /> 10 MUSIC S�UARE EAST,NASHVILLE,TN 37203-9901 <br /> FOR BMI USE ONLY i <br /> Account No. COID <br /> . :. _." _..: . �-- • BMI � �I <br /> " BMI and the Musicstand symbol are registered trademarks of Broadcast Music, Inc. � <br /> 4 � <br />