== Mr CLASSICAR, WRITER APPLICATION APPLICATION WILL NOT BE ACCEPTED UNLESS ALL QUESTIONS ARE ANS| PLEASE PRINT OR TYPE. 1. FULLLEGAL NAME: eo FisNamey (Gite Name ‘CaatNamey 2. COMPLETE MAILING ADDRESS:_ ear as Gi 4 FAX 3. PHONE: (___)- 5, EMAIL ADDRESS 6. DATEOF BIRTH: /__/ (Month) (ay) Wear) 7. CITIZENSHIP: _ 8. COUNTRY OF RESIDENCE FOR TAX PURPOSES: 9. LIST THE OTHER NAMES YOU HAVE USED AS A WRITER: (Do no! list band names, members, or co-writers) 10, Are you now ot have you ever been a writer-member or writeraffiliate of BMI, ASCAP, SESAC or any foreign performing rights licensing organization? If'so, state name of organization and the period during which you were a meaiber or affiliate: RECORD RELEASE DATE: FILM RELEASE DATE: NEXT CONCERT DATE: Tax 1D number for non-resident len isrequired. Please cal request he W-7 and WABEN forma. 11. SUBSTITUTE W-9 FOR AN INDIVIDUAL (Enter your name exactly as it appears on your Social Security card.) umber: (Enter your Social Security number) TAXPAYER Jdentificat CERTIFICATION Under penalties of perjury, Hertiy that: ‘A. The number shown on his forms my camct ex payer denicaton nome: (or fam wating for «number to be sued tome) and B Tam not subject o backup wahlolding because: (2) fam exempt fom backup witli, of) Ihave not ben tified byte Internal Revenue Service het lam subject o backup withtolding a result of failure o report all interes o dividends, o (the IRS has noifed re that Iam Inger subject to hakup witholding, ‘Certiention Instructions: You must ross ou item B shove i you have been notified by the IRS that you are erent ubjet to backup withholing 12. I warrant and represent hat al ofthe information on this applications. {acknowledge that ny contacts Betneen me nd BME wil entered int oa seliunce upon he representations conned inthis applicatian, and Gat the canact wil be subject oeacellaton iy question herein i ot eweed flyer seomately. = Dae ‘fepplicent is under 18 years of age, the parent or legal guardian must sign below and on both copies ofthe agreement (Guardian Printed Name: ‘Guardian Signature: FORINTERNAL USE ONLY "ACCOUNT NUMBER: TSJINGLES 2=TV 36 THEATRE 4=CONCERT $=JAZZ DATE RECEIVED: