1. INFORMATION REQUIRED:
   1. Title of work
      (Previous title, if any)
   2. Author(s): (Individual or corporate creator of work, or employer for whom work prepared)Name
      Citizenship
      Domicile
      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
      Address
      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 manuf acturered in U.S. or Canada, customs import statement may be required)
2. MATERIALS 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      • If unpublished work – one copy (best copy available)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 application if authorized to do so.