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ASCAP Licensing Fee
Submission Form

Note: This form must be submitted during the calendar
quarter of the concert event.

Chapter Information
Sponsoring Chapter
Name of Chapter Representative
E-Mail Address
Telephone
Event Information
Date of Event (MM/DD/YYYY) / /
Artist
Venue (Name of theatre, restaurant, etc.)
Address
City	State
Number of Performances	Seating Capacity
Attendance	Highest Admission Price
*Gross Revenue (ticket prices times number sold)
Additional Comments
*The gross revenue should not include facility restoration fees, taxes, parking, etc. The revenue information is kept confidential but is required to calculate the appropriate fee.

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