Application for Registration of a Copyright

For assistance in completing the form, please refer to the "Instructions" sheet. Please print.

1. Title of the work

2. Category of the work
Select the category or categories that best describe your work.

Literary    Musical    Artistic    Dramatic   

3. Publication

A. The work is published   B. The work is unpublished

Address

5. Owner(s) - (If more than one owner, please attach a list of names and
addresses of all the owners)

OR
B. Name of corporation

Address

6. Declaration
The applicant declares that he/she/it is:

7. Agent (if applicable)

OR
B. Name of firm

Address

8. Credit card payment

Credit card number:______________________ Expiration date:______________