THANK YOU FOR YOUR SUBMISSION PLEASE MAKE SURE YOU FILL OUT OR CHECK THE BOXES WITH ASTERIKS. THE FORM WON’T PROCESS WITHOUT FILLING OUT INFORMATION IN THIS AREAS Your Name (required) Your Email (required) Phone or Skype in Case There Are Any Questions How Were You Referred? —Please choose an option—TylerSamaWalterMendiBrian KarlBaiyeJohnMaxime If You Do Not See The Name of the Referrer, Please Write It The Name Here Artist or Band Name Song Title Music Genre (Choose the Closet Fit) AlternativeChristianCountryERM-Club-DanceFolkHip Hop-UrbanJazz-Blues-Folk-R&BMetal-AlternativeRapPopRockOther If Other Music Genre What Is It? The MODI Urban block airs only Rap,Hip-hop, R&B and Rhythmic music. The MODI RCM block airs only Rock, Country and Metal music. The MODI Mix block airs a wide variety of music genres ranging from Alternative, Blues, Jazz, Classical, Dance, Raggae, House, Instrumental, Electronic and World music to the Traditional and other Music Genres. On which Block would you want to be Played? MODI UrbanMODI RCMMODI MIX Select a Country United StatesCanadaMexicoUnited Kingdom-----AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArmeniaArubaAustraliaAustriaAzerbaijanAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaireBosnia and HerzegovinaBotswanaBouvet Island (Bouvetoya)BrazilBritish Indian Ocean Territory (Chagos Archipelago)British Virgin IslandsBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCuraçaoCyprusCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly See (Vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKazakhstanKenyaKiribatiKoreaKoreaKuwaitKyrgyz RepublicLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Netherlands)Slovakia (Slovak Republic)SloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia & S. Sandwich IslandsSpainSri LankaSudanSurinameSvalbard & Jan Mayen IslandsSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkeyTurkmenistanTurks and Caicos IslandsTuvaluU.S. Virgin IslandsU.S. Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUruguayUzbekistanVanuatuVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabwe Do You Agree With The Terms and Conditions Below regarding your submission? I AGREE...Music airing on MODI Radio is royalty free and solely for promotional purposes. I AGREE... I am giving MODI FM a direct license authority and all permissions not to pay any royalty for any sound recordings or music works, lyrics or any copyrighted content. I AGREE...I am the sole owner of all copyrights and intellectual property rights associated with the material being submitted and nothing submitted includes any content which infringes upon any copyright or any intellectual property right or trademark of any company, entity, or any person living or dead. I am solely legally responsible and accountable for the recorded material being submitted. I AGREE...I am giving MODI FM the right to broadcast all or only a selection of the material submitted completely royalty free for use in broadcasting, public play, or reproduction for broadcast. MODI FM’s agents are not subject to any royalty collection by any entity in relation to the music or material being submitted. MODI FM reserves the right to remove your music from our playlist if we find out that it infringes on any copyrights. I AGREE...All material submitted for broadcast are original recordings that are written, produced, composed, and performed by the artists or performers submitting the recordings. No Cover Music is allowed even if you have rights to use it, only original music can be submitted. There can be no explicit lyrics in the song. NO COVER MUSIC, NO EXCEPTIONS. The submission of Cover Music as your own music will cause the rejection of all of your music from broadcast. (Cover music is considered any music not originally produced by the submitting artist, traditional music may be exempt if over 100 years old and proven to be in the public domain.) I AGREE...If submitting party is a music label, recording company, artist management, or agent, submitting party declares full ability to submit songs and is authorized by artist to accept the terms and conditions listed above. I AGREE...If submitting party is a music label, recording company, artist management or agent. They are fully responsible for all legal and monetary damages arising from any disputes with artist over royalty for songs played on MODI FM [/acceptance] I AGREE...MODI FM’s music submission fees are non recurring and assessed a per song upload and editing fee of $59.95 for 30 days airplay, $85.95 for 60 days airplay and $105.95 for 90 days airplay. All upload fees are non-refundable. I AGREE...Terms subject to change without notice. YES, I AGREE I Have Full Authority And Hereby Agree And Authorize By Typing My Name Upload Your Song (ONLY MP3 files. Limit Song Size to 4 Minutes or less). IF YOU FEEL YOUR MUSIC FILE WILL BE TOO BIG, THEN SIMPLY EMAIL IT AS AN ATTACHMENT TO administrator@modifm.com