|
Copyright Questionnaire
|
|||||||
|
Title of Work:
|
|||||||
|
Previous Title
|
|||||||
|
Nature of Material:
|
|||||||
|
Authors:
|
(Complete for each author of the work, add additional
sheets if necessary)
|
||||||
|
Name of Author:
|
|||||||
|
Work made for hire:
|
Yes No
|
||||||
|
Author's Nationality:
|
USA
|
||||||
|
Date of Birth:
|
|||||||
|
Anonymous:
|
Yes No
|
||||||
|
Pseudonymous:
|
Yes No
|
||||||
|
Nature of Authorship:
|
|||||||
|
Name of Author:
|
|||||||
|
Work made for hire:
|
Yes No
|
||||||
|
Author's Nationality:
|
USA
|
||||||
|
Date of Birth:
|
|||||||
|
Anonymous:
|
Yes No
|
||||||
|
Pseudonymous:
|
Yes No
|
||||||
|
Nature of Authorship:
|
|||||||
|
Name of Author:
|
|||||||
|
Work made for hire:
|
Yes No
|
||||||
|
Author's Nationality:
|
USA
|
||||||
|
Date of Birth:
|
|||||||
|
Anonymous:
|
Yes No
|
||||||
|
Pseudonymous:
|
Yes No
|
||||||
|
Nature of Authorship:
|
|||||||
|
Year work completed:
|
|||||||
|
Date of First Publication:
|
|||||||
|
Nation of First Pub.:
|
USA
|
||||||
|
Copyright Claimant:
|
|||||||
|
If assigned to Copyright Claimant, provide copy of assignment
|
|||||||
|
Previous Registration
|
YES No If Yes: First pub. of previously unregistered work First application by this claimant Changed version of prior work |
||||||
|
If Derivative Work identify pre-existing materials
|
|||||||
|
If Derivative Work identify material added to this Work
|
|||||||
|
Gordon Troy is authorized agent to file Copyright application
|
YES
|
||||||
|
For visual works, please complete the following
|
|||||||
|
Nature of Authorship:
|
|
||||||
|
For sound recordings, please complete the following
|
|||||||
|
Selection Title
|
Words
|
Music | Performance | Sound Recording | Original Work | ||
|
WebTM
is a registered trademark of Gordon E. R. Troy, PC |
||
|
© 1995-2008,
Gordon E. R. Troy, PC, Charlotte, Vermont, USA - All Rights Reserved |
||
|
|
||