Get Application Form For Writer

WRITER MEMBERSHIP APPLICATION FORM Please complete and print for your records. On completion please hit Submit E-mail button Prefix Mr. Family Name First Name Address Telephone Home Telephone Business Telephone mobile E-mail Fax Sobriquet/Pseudonym Date of Birth Country of Birth Nationality Country of Residence Do you create Music Do you perform your own works Yes Musical Style You are a member of the groups Are you or have you ever been a member of any other performing rights society Yes If so which ROYALTY PAYMENT DETAILS COTT prefers to pay royalties straight into your account. Please provide details below Name of Bank/Credit Union Branch Account Name Page 1 of 3 MUSICAL ACTIVITIES In order to qualify for COTT membership please complete at least one of the sections below COMMERCIAL RECORDINGS Please provide the name s of artist s record label label number s date s of release s territories of release and a list of of the titles recorded* Please include a copy of the commercial recording or a photocopy of the label* please use upload box for this feature RADIO FILM OR TELEVISION PERFORMANCES indicate the stations title of programmes or films name of producers and dates of performances. indicate cities names of the venues and dates of performances. Attach evidence of at least one live performance - that is ticket stub flyer newspaper listing or advertisement etc* PUBLISHER ASSIGNMENT indicate name s of Publishers s and submit copy ies of published agreements s. I apply for membership in the Organization and agree that upon acceptance as a Member I shall execute an agreement with COTT and shall abide by the Organization s By-laws and Rules as enacted from time to time by its Board of Directors. Date Applicant s Signature 11/7/11 Please note This form must also be signed by a parent or guardian if the applicant is under legal age. Parent/Guardian signature Name Submit by Email Print Form FOR OFFICIAL USE ONLY Date application accepted Qualifications Date contracts sent. Family Name First Name Address Telephone Home Telephone Business Telephone mobile E-mail Fax Sobriquet/Pseudonym Date of Birth Country of Birth Nationality Country of Residence Do you create Music Do you perform your own works Yes Musical Style You are a member of the groups Are you or have you ever been a member of any other performing rights society Yes If so which ROYALTY PAYMENT DETAILS COTT prefers to pay royalties straight into your account. Please provide details below Name of Bank/Credit Union Branch Account Name Page 1 of 3 MUSICAL ACTIVITIES In order to qualify for COTT membership please complete at least one of the sections below COMMERCIAL RECORDINGS Please provide the name s of artist s record label label number s date s of release s territories of release and a list of of the titles recorded* Please include a copy of the commercial recording or a photocopy of the label* please use upload box for this feature RADIO FILM OR TELEVISION PERFORMANCES indicate the stations title of programmes or films name of producers and dates of performances.