NOTE: This form is not intended as legal advice, nor is it a solicitation for engagement. Rather, this form is supplied as a convenience for those seeking legal assistance from any copyright attorney.

COPYRIGHT INTAKE FORM

Instructions: Provide the following information and promptly confer with your attorney
to develop a proper course of action.

1. Title of Work: ________________________________________________________
_____________________________________________________________________
(include revision number)
Previous/Alternate Title(s): _______________________________________________

2. Nature of Work: _____________________________________________________
_____________________________________________________________________

3. Author's full name and date of birth: _________________________________________
Address: ___________________________________________________________

4. If 'work for hire' **, or transferred by written agreement, then
Employer/Owner name: _____________________________________________________
Address: ___________________________________________________________

5. Year in which work was completed: _______________________________________
Date and Nation of first publication/sale: ___________________________________

6. Earlier work previously registered? Previous reg. no. _______________________
Year of previous registration: ___________________________________________

7. Derivative Work/Compilation
Identify any Pre-existing work that this work is based on or incorporates: _________
___________________________________________________________________
___________________________________________________________________

Brief, general statement of the material added to this work for which copyright
protection is claimed: _________________________________________________
__________________________________________________________________

** 'work for hire' is defined as (1) a work prepared by an employee within the scope of
employment; or (2) a specially ordered or commissioned work where the parties agree
in writing that the work is a 'work for hire' and that ownership resides with the employer.

(Requires multiple copies of the work to be submitted as deposit materials)

Additional Copyright Information:

Copyright Basics provides general information about copyright law, and sources of further information.
Digital Millennium Copyright Act (DMCA) is a complex piece of legislation intended to clarify the applicability of copyright law to the digital environment.