Copyright Registration - Advance - 499

What copyright do you want?

What is it that you are looking for copyright?

Copyright Title

What is the title of work you would like to copyright?

Year of Completion?

What year did you complete your work?

Has the work been published?

Date of Publication?

Country of Publication?

Published electronically?

Work part of organization?

Is your work a part of a larger periodical (newspaper, magazine) or serial?

Full Name/Organization

Is there more than 1 author?

Author's Name 1

Author's Address 1

Enter Author #1's Address (include the the City, State & Zip/Postal Code)

Author's Date of Birth 1

Author's Date of Death 1

Was this author's work made for hire? 1

Author's Nationality or Domicile 1

Was this author's work made anonymously? 1

Nature of Authorship 1

Author's Name 2

Author's Address 2

Enter Author #2's Address (include the the City, State & Zip/Postal Code)

Author's Date of Birth 2

Author's Date of Death 2

Was this author's work made for hire? 2

Author's Nationality or Domicile 2

Was this author's work made anonymously? 2

Nature of Authorship 2

Author's Name 3

Author's Address 3

Enter Author #3's Address (include the the City, State & Zip/Postal Code)

Authors DOB 3

Author's DOD 3

Was this author's work made for hire? 3

Author

Was this author's work made anonymously? 3

Nature of Authorship 3

Copyright Claimant(s)

Name and address must be given even if the claimant is the same as the author given above

Transfer

If the claimant(s) named here is/are different from the author(s) named in the previous secrion, give a brief statement of how the claimant(s) obtained ownership of the copyright.

Previous/Alternative Titles

Previous Registration?

Has registration for this work, or for an earlier version of this work already been made in the Copyright Office?

Previous Registration Cont.

This is the first published edition of a work previously registered in unpublished form.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, as described below in Prexisting Material or Material Added to This Work

Please choose 1 option

Previous Registration Number

Previous Registration Year

Prexisting Material

Complete this section if you answered Yes to the previous question. Identify any prexisting work or works that this work is based on or incorporates.

Material Added to This Work

Complete this section if you answered Yes to the previous question. Give a brief, general statement of material that has been added to this work and in which copyright is claimed.

Correspondence

Give name, address, phone/fax and/or email to which correspondence about this application should be sent.

Certification *

I, the undersigned, hereby certify that I am the

Author
Other Copyright Claimant
Owner of Exclusive right(s)
Authorized Agent of...

Please choose 1 option

Certrification Agent

Authorized Agent of...

Certification Name

Certification Date

Certification Mail To

Certification will be mailed to the following name and address listed below (Please include : Name, Number, Street, Apt, City, State, Zip)