Screenplay - Joint Authors/Derivative

Please have a PDF file of your script ready to upload before you fill out the form below. The PDF file should not contain any material other than the text of the script–e.g., no artwork decorating the cover page. THE COPYRIGHT OFFICE DOES NOT ACCEPT FDX FILES.

Application form for jointly authored screenplays and/or screenplays based on other works.

FD Screenplay Joint/Derivative

The individual filling out this form should be one of the authors of the screenplay. Additionally, Author 1 will be the Point of Contact for both the Copyright Office and RightsClick.

I understand.

Screenplay Title

Date of Completion

This screenplay is:

Published

Unpublished

Nation of First Publication

Date of First Publication

Was this screenplay FIRST published in physical form?

Yes

For works first published in physical form, two physical copies must be mailed to the Copyright Office. RightsClick will email you the shipping form after submitting your application.

The Copyright Office requires that any preexisting authorship, even your own, be disclaimed from the new authorship in this work. In order to know what, if anything, should be disclaimed, please answer the next two questions.

Does this sceenplay contain more than a negligible amount of material quoted from other works?

Yes

Check either or both.

Text

Lyrics

Is this screenplay based on another work?

Yes

Do you have permission to write this adaptation, sequel, spin-off, etc.?

Yes

The Copyright Office may reject an application to register a derivative work if permission has not been obtained from the copyright owner of the prior/source work. We recommend seeking legal advice on this matter before you apply.

Please describe the work on which the screenplay is based.

Was AI used to produce any part of this screenplay?

Yes

Describe your use of AI in relation to your own work.

Author 1 First Name

Middle Name/Initial

Last Name

Author 1 Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Author 1 Email

Author 1 Phone (optional)

Author 1 Birth Year (optional)

Add Author 2?

Yes

Author 2 Birth Year (optional)

Author 2 First Name

Middle Name/Initial

Last Name

Author 2 Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Add Author 3?

Yes

Author 3 Birth Year (optional)

Author 3 First Name

Middle Name/Initial

Last Name

Writer 3 Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Add Author 4?

Yes

Author 4 Birth Year (optional)

Wrter 4 First Name

Middle Name/Initial

Last Name

Author 4 Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

The above-listed Author(s) is/are the copyright owner(s) in the work.

Confirmed.

Who should be contacted about obtaining rights to your screenplay?

Author 1/Point of Contact

Other Party (e.g., agent, attorney)

Rights Contact First Name

Last Name

Please enter at least one form of cotact for this person.

Rights Contact Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Rights Contact Phone

Rights Contact Email

The Copyright Office should mail the registration certificate to:

Author 1/Point of Contact

Other Party (e.g., agent,attorney)

First Name

Last Name

Mail Certificate Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Any other notes to the Copyright Office you wish to provide? (optional)

I have read and understood the instructions on the page accopanying this form.

Agreed.

Confirmation per Copyright Office:

17 USC 506(e): Any person who knowingly makes a false representation of a material fact in the application for copyright registration provided by section 409, or in any written statement filed with the application, shall be fined not more than $2500. I certify that I am the author, copyright claimant, and owner of all copyright rights in this work, or the authorized agent of the author, copyright claimant, and owner of all copyright rights in this work and that the information given in this application is correct to the best of my knowledge.

Confirmation per RightsClick^®:

I acknowledge that I will be charged $89.95. This constitutes a non-refundable USCO Filing Fee of $65 and a RightsClick processing fee of $24.95. I also grant RightsClick, Inc. permission to file this application with the U.S. Copyright Office by electronically signing my name on my behalf. I further acknowledge that RightsClick provides this service as a convenience. All future communications, including the status of my application are my responsibility. RightsClick will also add my email to their mailing list.

I agree to the above.

Agree.

I have read and agree to RightsClick Inc.’s Terms and Conditions.

Please type your name as you would sign it.

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