Radio Waiver

BellaOnline Radio - Fantastic Women, Fantastic Music

This release form allows the BellaOnline radio station to play the original music of independent female artists. Please print this form out and fill it out. Then take a picture of it and email it to Let us know where we can download your music to get started! If you only have it in CD form, let us know that and we'll let you know how to mail that to us.

Release Form


(First Name, Last Name)

(Street Address)


(State, Zip Code, Country)

(Email Address)
give permission to:

to reproduce (for broadcasting purposes) and broadcast my music via the internet, namely an internet radio and website (

The songs listed below may be reproduced (for broadcasting purposes) and broadcast:

Song Title(s)

Signed: _______________________________________

Printed: ______________________________________
I hold the copyright for the above songs.

I give permission for to use any included artwork to promote the above music on
Initials: _______________

Date: __________________

Printable Version

BellaOnline Radio Station