1. Title of work
      (Previous title, if any)
    2. Author(s): (Individual or corporate creator of work, or employer for whom work prepared)Name
      Anonymous or Fictitious Name
      Contribution (i.e. entire work, words, music, etc.)
    3. Year of Creation (Completion)
    4. Publication (if any, namely distribution of copies to public for sale, lease,etc., or offering to distribute copies to a group of persons for further distribution)Full date _____ Month _____ Day _____ Year Country
    5. Owner: (Author or person obtaining ownership from author. See 2 above.)Name
      How Acquired (Assignment, etc.)
    6. If derivative work advise of pre-existing material incorporated therein, and/or material added to prior work
    7. If literary work in English, list names of manufacturers and places of manufacture (Note if not manufactured in U.S. or Canada, customs import statement may be required)
    1. Provide for filing (will not be returned by Copyright Office)
      • If unpublished work – one copy (best copy available)
      • If published work (see paragraph 4 above) two copies (best copies available)
      • If three-dimensional work (ceramics, carvings, models et al.) color photographs at least 3 X 3 inches and no larger than 9 X 12 inches showing work.
    2. Application for registration
      • We can sign an application if authorized to do so.