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Application Form
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*
Please choose type of work
--Select--
Visual Arts
Performing Arts
Literary Works
Sound Recording
Motion Picture/Audio Visual
*
Title Of The Work (or collection of works)
Previous or Alternative Titles, if any
Publication as Contribution (Literary or Serial)
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*
Author’s Name
*
Year Work Was Completed
*
Author’s Nationality Or Domicile
Organization Name
*
Year Born
Year Died
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*
Work Made For Hire?
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Yes
No
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Please describe your work in a few words
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Anonymous Or Pseudonymous
*
Has the author chosen not to reveal
his or her name on the work?
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Yes
No
*
Has the author chosen to use a
fictitious name on the work?
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Yes
No
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*
Has This Work Been Published?
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Yes
No
If yes, Please Select date and nation of First Publication.
Date of First Publication.
Nation of First Publication.
*
Has This Work Been Preregistered
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Yes
No
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Copyright Claimants
*
Name
*
Street Address
*
City
*
State
*
Zip Code
*
Telephone Number
Fax Number
*
Email
Organization
Name and Address of additional Claimants
Transfer
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Previous Registration
*
Has registration for this work or for an earlier work already been made in the Copyright Office?
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Yes
No
If yes, reason for another registration?
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This is the first published edition of a work previously registered in unpublished form.
This is the first application submitted by this author as copyright claimant.
This is a changed version of the work.
Year of Registration
Previous Registration No
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Derivative Work Or Compilation?
Does your work contain preexisting material?
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Correspondence
Check If Same As Copyright Claimant
*
Name
*
Street Address
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City
*
State
*
Zip Code
*
Telephone Number
Fax Number
*
Email
Public Record Information
*
Do you wish to have your email listed in the online public record at the Copyright Office?
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Yes
No
*
Do you wish to have your phone number listed in the online public record at the Copyright Office?
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Yes
No
How would you like to submit your work to us?
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