In order to compose your Edusong I will need some information. Please fill out the form below. All fields are required.

First Name:

Last Name:

Phone:

(with area code)

Street Address:

City:

State:

Zip Code:

Email Address:

Subject:

Grade level:

Approximate date needed by (At least 1 week from today):

Specific information. (Name of book and author, specific lesson or any other details I will need.)


By checking this box, I acknowledge that the copyright of this song is to be retained
by the songwriter and that the song will not be used for any commercial purposes.
Please send me an e-mail if there is any information that you left out of the form but want included in the song.