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Ed pursuant to the laws of the State of Delaware, c/o Suite 500, 266 King Street West, Toronto, Ontario, M5V 1H8, Attention: Robert Ott Telephone: (416) 619-2051 (the "Publisher'') -andName: Address: Affiliation: Telephone: Email: Publishing Company Designee: ASCAP/BMI ( ) -and- Name: Address:.

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