TCC Consent Form

By signing below I give the Dance Notation Bureau (DNB) permission to use my course outline, lesson plans, and teaching demonstration videos or other images for the DNB's educational use. I understand the DNB may edit these materials and post them on the DNB Web Site. I understand that I will receive no compensation for the DNB’s use of the materials.

Please initial which materials you agree to release.

My course outline may be used: I agree (initial here) _____

My lesson plans may be used: I agree (initial here) _____

My videos and images may be used: I agree (initial here) _____

This agreement is binding on successors, assignees and/or heirs.

Signature:

Print Name:

Date:

This form may be scanned and e-mailed, faxed, or mailed to:

Dance Notation Bureau 111 John Street, Suite 704 New York, NY 10038

Phone: 212-571-7011

Fax: 212-571-7012

e-mail: dnbinfo@dancenotation.org

website: http://www.dancenotation.org