Screenplay - Single Author

FD Screenplay Sole Author

ALL the work contained in the Deposit Copy you will submit is your own, new work.

Correct.

What is the title of your screenplay?

On what date was it completed?

This screenplay is:

Published

Unpublished

What is the date of first publication?

What is the nation 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.

First Name

Middle Name/Initial

Last Name

Your Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Your Email

Your Phone/Mobile (optional)

Who is the rights contact for this screenplay?

I Am

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

Rights Contact First Name

Last Name

For the rights contact, you must enter at least an address, email, or phone number. You may enter all three.

Rights Contact Info

Address Line 1

Address Line 2

City

State

Zip Code

Country

Rights Contact Email (optional)

Rights Contact Phone (optional)

Who should receive the registration certificate?

I Should

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

Mail registration certificate to:

Last Name

Mail Certificate Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

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

I have read and understood the instructions on the pages 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 $69.95. This constitutes a non-refundable USCO Filing Fee of $45 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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Screenplay – Single Author

Application for a screenplay written by one author who is the sole copyright owner.