Copyright Application

If you have entered this page by error, or wish to exit, click here.

* Indicates a required field
Salutation
*First Name
Middle Name or Initial
*Last Name
*Date of Birth
Company/Individual
E-mail
*Phone: Primary
      Secondary
      Cell Phone
Fax
*Address
Address 2
Address 3
*City
*State
*Country
*Zip Code

State the title and previous or alternative title(s) of the work.
*Title

Previous or Alternative Titles

*Year Completed

Names, citizenship and date of birth for the authors

*Author 1
Name
Citizenship
Date if birth

Author 2
Name
Citizenship
Date if birth

Author 3
Name
Citizenship
Date if birth

Author 4
Name
Citizenship
Date if birth

*Identify the nature of each author's contribution to the work.
*Author 1

Author 2

Author 3

Author 4

If you are not the author and are claiming the copyright, briefly state the basis for your claim.
If based upon pre-existing material or if it includes any pre-existing material, identify the pre-existing material and explain how your work differs from it.
If the material has been published or publicly distributed, provide the country of the first publication or distribution and the date it was first published or distributed.
Country
Date:

Was the work created in an employment setting?  If so explain the situation.
Has this material, or a previous version been previously registered with the Copyright Office-ifyes, explain the situation.
YesNo
Previous registration number
Year of regisration
Submission of this form does not create an attorney-client relationship, unless or until the Power of Attorney and any fees have been submitted and accepted by this office.