Children's Music Web

Penelope's Radio Release Form

Your name:

Your address:

Your phone:

Your contact phone, publishable on the web, if different (800 number, etc):

Your email:

Your website URL:

ASCAP? BMI? SOCAN?

I hereby give the Children's Music Web, Pickleberry Pie Inc., and Penelope's Radio permission to use portions of my wholly-owned recordings,

( list recordings here:)

on its website for public information purposes. I certify that I am the copyright owner of these recordings. I retain all rights to this material.

_________________________

your signature

______________________

date

Send to: 305 Dickens Way Santa Cruz, CA 95064 USA