Copyright Intake Form

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Copyright Registration Intake Form

Please fill out this form as accurately as possible and we will get in touch with you shortly.

Name
First Last
Email
What is the title of the work?*
List any previous or alternative titles.*
What type of work is this?*
If other, please specify*
Briefly describe the nature of the material (ex. Text of children's book):*
Has the work been published (to prepare and issue for public distribution or sale)?*
Title of the collected work:*
Volume, Number, Issue Date, and Pages the Work appears on.*
Country where this work was first published.*
Year in which this work was completed.*
Has the work been preregistered with the Copyright Office? If so, what is the preregistration number?*
Author’s name (The author is the person who created the work, unless the work was “made to hire”, then the employer is the author)*
Author's Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Author's country of citizenship.*
Author's place of domicile (permanent legal residence)*
Author's year of birth and year of death if applicable.*
Was the author's contribution to the work:*
What is the pseudonym?*
Indicate the author's contribution*
If other please specify*
If anyone other than the Author listed contribute to this work, list each contributor and describe their contributions:
Please identify the copyright claimant (owner) of this work. Has the author transferred his copyright to another person or organization? If not, the author is the copyright claimant. If so, the person or organization is the claimant. NOTE: if claimant is anyone other than the author, must include a transfer statement (i.e., by written agreement, by inheritance).*
First Last
Email address of the copyright claimant*
Address of the copyright claimant*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone number of copyright claimant*
Please identify the copyright claimant (owner) of this work. Has the author transferred his copyright to another person or organization? If not, the author is the copyright claimant. If so, the person or organization is the claimant. NOTE: if claimant is anyone other than the author, must include a transfer statement (i.e., by written agreement, by inheritance).