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n any written statement filed in connection with the application, shall be fined not more than $2,500. Rev: June 2002--20,000 Web Rev: June 2002 U.S. Government Printing Office: 2000-461-113/20,021 07-3000. City/State/ZIP *17 U.S.C. § 506(e): Any person who knowingly makes a false representation of a material fact in the application for copyright registration provided for by section 409, or igton, D.C. 20559-6000 Name Number/Street/Apt 9 Fees are subject to change. For current fees, check the Copyright Office website at www.copyright.gov, write the Copyright Office, or call (202) 7cation form 2. Nonrefundable filing fee in check or money order payable to Register of Copyrights 3. Deposit material MAIL TO: Library of Congress Copyright Office 101 Independence Avenue, S.E. Washinmailed in window envelope to this address: Handwritten signature (X) x YOU MUST: · Complete all necessary spaces · Sign your application in space 8 SEND ALL 3 ELEMENTS IN THE SAME PACKAGE: 1. Applilusive right(s) authorized agent of Typed or printed name and date If this application gives a date of publication in space 3, do not sign and submit it before that date. Date Certificate will be ve right(s) of the work identified in this application and that the statements made by me in this application are correct to the best of my knowledge. { author other copyright claimant owner of exc daytime telephone number Email ( ) Fax number ( ) CERTIFICATION* I, the undersigned, hereby certify that I am the Check only one Name of author or other copyright claimant, or owner of exclusie name and number of Account. Name Account Number CORRESPONDENCE Give name and address to which correspondence about this application should be sent. Name/Address/Apt/City/State/ZIP Area code andhe material that has been added to this work and in which copyright is claimed. DEPOSIT ACCOUNT If the registration fee is to be charged to a Deposit Account established in the Copyright Office, giv 6b for a compilation. Preexisting Material Identify any preexisting work or works that this work is based on or incorporates. 6 7 8 Material Added to This Work Give a brief, general statement of ttructions before completing this space. If your answer is "Yes," give: Previous Registration Number DERIVATIVE WORK OR COMPILATION Complete both space 6a and 6b for a derivative work; complete only. This is the first application submitted by this author as copyright claimant. This is a changed version of the work, as shown by space 6 on this application. Year of Registration 5 a b a b See ins another registration being sought? (Check appropriate box.) If your answer is No, do not check box A, B, or C. This is the first published edition of a work previously registered in unpublished formINUATION SHEET. PREVIOUS REGISTRATION Has registration for this work, or for an earlier version of this work, already been made in the Copyright Office? Yes a. b. c. No If your answer is "Yes," why ise 8. DO NOT WRITE HERE Page 1 of pages EXAMINED BY CHECKED BY FORM PA Yes CORRESPONDENCE FOR COPYRIGHT OFFICE USE ONLY DO NOT WRITE ABOVE THIS LINE. IF YOU NEED MORE SPACE, USE A SEPARATE CONTained ownership of the copyright. FUNDS RECEIVED MORE ON BACK · Complete all applicable spaces (numbers 5-9) on the reverse side of this page. · See detailed instructions. · Sign the form at linmpleting this space. TWO DEPOSITS RECEIVED TRANSFER If the claimant(s) named here in space 4 is (are) different from the author(s) named in space 2, give a brief statement of how the claimant(s) obtar Nation COPYRIGHT CLAIMANT(S) Name and address must be given even if the claimant is the same as the author given in space 2. APPLICATION RECEIVED ONE DEPOSIT RECEIVED See instructions before cor in all cases. DO NOT WRITE HERE OFFICE USE ONLY 3 4 a b DATE AND NATION OF FIRST PUBLICATION OF THIS PARTICULAR WORK Complete this information ONLY if this work has been published. Month Day Yein NATURE OF AUTHORSHIP Briefly describe nature of material created by this author in which copyright is claimed. YEAR IN WHICH CREATION OF THIS WORK WAS COMPLETED This information must be given Yea Yes No OR { WAS THIS AUTHOR'S CONTRIBUTION TO If the answer to either THE WORK Anonymous? Pseudonymous? Yes Yes No No of these questions is "Yes," see detailed instructions. Citizen of Domiciled ich copyright is claimed. NAME OF AUTHOR DATES OF BIRTH AND DEATH Year Born Year Died AUTHOR'S NATIONALITY OR DOMICILE Name of Country c Was this contribution to the work a "work made for hire"?ous? Pseudonymous? Yes Yes No No of these questions is "Yes," see detailed instructions. Citizen of Domiciled in NATURE OF AUTHORSHIP Briefly describe nature of material created by this author in wh AUTHOR'S NATIONALITY OR DOMICILE Name of Country b Was this contribution to the work a "work made for hire"? Yes No OR { WAS THIS AUTHOR'S CONTRIBUTION TO If the answer to either THE WORK Anonymf birth and death blank. NATURE OF AUTHORSHIP Briefly describe nature of material created by this author in which copyright is claimed. NAME OF AUTHOR DATES OF BIRTH AND DEATH Year Born Year Died rt of this work that was "made for hire" check "Yes" in the space provided, give the employer (or other person for whom the work was prepared) as "Author" of that part, and leave the space for dates oons is "Yes," see detailed instructions. Citizen of Domiciled in NOTE Under the law, the "author" of a "work made for hire" is generally the employer, not the employee (see instructions). For any pantry Was this contribution to the work a "work made for hire"? Yes No OR { WAS THIS AUTHOR'S CONTRIBUTION TO If the answer to either THE WORK Anonymous? Pseudonymous? Yes Yes No No of these questiITLE OF THIS WORK PREVIOUS OR ALTERNATIVE TITLES NATURE OF THIS WORK See instructions NAME OF AUTHOR DATES OF BIRTH AND DEATH Year Born Year Died AUTHOR'S NATIONALITY OR DOMICILE Name of CouS COPYRIGHT OFFICE REGISTRATION NUMBER b PA PAU EFFECTIVE DATE OF REGISTRATION Month Day Year DO NOT WRITE ABOVE THIS LINE. IF YOU NEED MORE SPACE, USE A SEPARATE CONTINUATION SHEET. 1 2 a Tt to fill out and start typing. When done, press the "Print" button. To erase/reset all fields, press the "Clear" button. Print All Forms Clear FORM PA For a Work of the Performing Arts UNITED STATEheck the Copyright Office website at www.copyright.gov, write the Copyright Office, or call (202) 707-3000. This form can be filled out right on the screen. Simply go to the section/field that you wanample, a song (the work to be registered) can be reproduced in sheet music ("copies") or phonograph records ("phonorecords"), or both. Copyright Office fees are subject to change. For current fees, coks, sheet music, film, and videotape. They may also be fixed in "phonorecords," objects embodying fixations of sounds, such as tapes and phonograph disks, commonly known as phonograph records. For exfollows: Musical compositions may be embodied (fixed) in "copies," objects from which a work can be read or visually perceived, directly or with the aid of a machine or device, such as manuscripts, boding differ, or you prefer to have separate registration for them. "Copies" and "Phonorecords": To register for copyright, you are required to deposit "copies" or "phonorecords." These are defined as ying musical or dramatic work and the sound recording, and you prefer to register both on the same form. (5) File both forms PA and SR if the copyright claimant for the underlying work and sound recor that results from the fixation of a series of musical, spoken, or other sounds, but not the underlying musical or dramatic work. (4) File Form SR if you are the copyright claimant for both the underl work, such as a motion picture soundtrack; these are considered integral parts of the audiovisual work. (3) File Form SR if you are seeking to register the "sound recording" itself, that is, the work not the "sound recording," even though what you deposit for copyright purposes may be in the form of a phonorecord. (2) File Form PA if you are seeking to register the audio portion of an audiovisualnstance, Form SR may also be used to file for a copyright registration for both kinds of works--see (4) below.) Therefore: (1) File Form PA if you are seeking to register the musical or dramatic work,fixation of a series of sounds," separate and distinct from the underlying musical or dramatic work. Form SR should be used when the copyright claim is limited to the sound recording itself. (In one ied to register the underlying musical composition or dramatic work. Form SR has been developed specifically to register a "sound recording" as defined by the Copyright Act--a work resulting from the " (as a tape, disk, or cassette), you may choose either copyright application Form PA (Performing Arts) or Form SR (Sound Recordings), depending on the purpose of the registration. Form PA should be us 7,8,9 SPACE 7, 8, 9: Fee, Correspondence, Certification, Return Address MORE INFORMATION How to Register a Recorded Work: If the musical or dramatic work that you are registering has been recordedhe author, claimant, or owner of exclusive right(s). Address for Return of Certificate (space 9): The address box must be completed legibly since the certificate will be returned in a window envelope.ication cannot be accepted unless it bears the date and the handwritten signature of the author or other copyright claimant, or of the owner of exclusive right(s), or of the duly authorized agent of ts, area code, telephone number, fax number, and email address (if available) of the person to be consulted if correspondence about this application becomes necessary. Certification (space 8): The applright Office, identify it in space 7a. Otherwise, leave the space blank and send the fee of $30 with your application and deposit. Correspondence (space 7b): This space should contain the name, addres earlier registration number and date. Otherwise, do not submit Form PA; instead, write the Copyright 5 SPACE 5: Previous Registration Deposit Account: If you maintain a Deposit Account in the Copy as copyright claimant in the earlier registration, and the author is now seeking registration in his or her own name. If either of these two exceptions applies, check the appropriate box and give theble unless: (1) the work has been registered in unpublished form and a second registration is now being sought to cover this first published edition; or (2) someone other than the author is identified be made for the same version of a particular work. Same Version: If this version is substantially the same as the work covered by a previous registration, a second registration is not generally possiintended to show whether an earlier registration has been made for this work and, if so, whether there is any basis for a new registration. As a general rule, only one basic copyright registration canat has been compiled and the compilation itself. Example: "Compilation of 19th Century Military Songs." 6 SPACE 6: Derivative Work or Compilation General Instructions: The questions in space 5 are stra"; "Dramatization for television"; "New film version"; "Revisions throughout; Act III completely new." If the work is a compilation, give a brief, general statement describing both the material thof the additional new material covered by the copyright claim for which registration is sought. In the case of a derivative work, identify this new material. Examples: "Arrangement for piano and orchee, the preexisting material might be: "French version of Hugo's `Le Roi s'amuse'." Do not complete this space for compilations. Material Added to This Work (space 6b): Give a brief, general statement uthorship. Preexisting Material (space 6a): Complete this space and space 6b for derivative works. In this space identify the preexisting work that has been recast, transformed, or adapted. For examplst, transformed, or adapted." Derivative works also include works "consisting of editorial revisions, annotations, or other modifications" if these changes, as a whole, represent an original work of aing works." Examples of derivative works include musical arrangements, dramatizations, translations, abridgments, condensations, motion picture versions, or "any other form in which a work may be recaa that are selected, coordinated, or arranged in such a way that the resulting work as a whole constitutes an original work of authorship." A "derivative work" is "a work based on one or more preexist been published or registered for copyright or that have fallen into the public domain. A "compilation" is defined as "a work formed by the collection and assembling of preexisting materials or of datPACE 4: Claimant(s) General Instructions: Complete space 6 if this work is a "changed version," "compilation," or "derivative work," and if it incorporates one or more earlier works that have alreadybtained ownership of the copyright. Examples: "By written contract"; "Transfer of all rights by author"; "Assignment"; "By will." Do not attach transfer documents or other attachments or riders. 4 Statement of how the claimant obtained ownership of the copyright." If any copyright claimant named in space 4 is not an author named in space 2, give a brief statement explaining how the claimant(s) oright initially belonging to the author has been transferred. Transfer: The statute provides that, if the copyright claimant is not the author, the application for registration must contain "a brief s in the case of a work made for hire, the employer or other person for whom the work was prepared). The copyright claimant is either the author of the work or a person or organization to whom the copy: Give the name(s) and address(es) of the copyright claimant(s) in this work even if the claimant is the same as the author. Copyright in a work belongs initially to the author of the work (including, Registration Number and Date: If more than one previous registration has been made for the work, give the number and date of the latest registration. Name(s) and Address(es) of Copyright Claimant(s)o cover the additions or revisions, check the last box in space 5, give the earlier registration number and date, and complete both parts of space 6 in accordance with the instructions below. Previouscation Office for information about supplementary registration or recordation of transfers of copyright ownership. Changed Version: If the work has been changed and you are now seeking registration te country where, publication first occurred. If first publication took place simultaneously in the United States and other countries, it is sufficient to state "U.S.A." 3 SPACE 3: Creation and Publian "offering to distribute copies or phonorecords to a group of persons for purposes of further distribution, public performance, or public display." Give the full date (month, day, year) when, and thlication" as "the distribution of copies or phonorecords of a work to the public by sale or other transfer of ownership, or by rental, lease, or lending"; a work is also "published" if there has been e author completed the particular version for which registration is now being sought, even if other versions exist or if further changes or additions are planned. Publication: The statute defines "pubs been prepared over a period of time, the part of the work existing in fixed form on a particular date constitutes the created work on that date. The date you give here should be the year in which thdate and nation of first publication only if the work has been published. Creation: Under the statute, a work is "created" when it is fixed in a copy or phonorecord for the first time. Where a work haAuthor(s) General Instructions: Do not confuse "creation" with "publication." Every application for copyright registration must state "the year in which creation of the work was completed." Give the loyment"; or (2) "a work specially ordered or commissioned for use as a contribution to a collective work, as a part of a motion picture or other audiovisual work, as a translation, as a 2 SPACE 2: n for whom the work was prepared is considered the author." What is a "Work Made for Hire"? A "work made for hire" is defined as: (1) "a work prepared by an employee within the scope of his or her empbe given. Unless the work was "made for hire," the individual who actually created the work is its "author." In the case of a work made for hire, the statute provides that "the employer or other persoase of a collective work such as a songbook or a collection of plays, give information about the author of the collective work as a whole. Name of Author: The fullest form of the author's name should information about every "author" who contributed any appreciable amount of copyrightable matter to this version of the work. If you need further space, request additional Continuation Sheets. In the cRevisions." General Instructions: After reading these instructions, decide who are the "authors" of this work for copyright purposes. Then, unless the work is a "collective work," give the requested to the work. Examples: "Words"; "Coauthor of Music"; "Words and Music"; "Arrangement"; "Coauthor of Book and Lyrics"; "Dramatization"; "Screen Play"; "Compilation and English Translation"; "Editorial untry in which the author is domiciled. Nationality or domicile must be given in all cases. Nature of Authorship: Give a brief general statement of the nature of this particular author's contribution a form of identification. Leave this space blank if the author's contribution was a "work made for hire." Author's Nationality or Domicile: Give the country of which the author is a citizen, or the co: If the author is dead, the statute requires that the year of death be included in the application unless the work is anonymous or pseudonymous. The author's birth date is optional, but is useful as e and which is the pseudonym (for example: "Judith Barton, whose pseudonym is Madeline Elster"). However, the citizenship or domicile of the author must be given in all cases. Dates of Birth and Deathus" you may: (1) leave the line blank; or (2) give the pseudonym and identify it as such (example: "Huntley Haverstock, pseudonym"); or (3) reveal the author's name, making clear which is the real namhonorecords under a fictitious name. If the work is "anonymous" you may: (1) leave the line blank; or (2) state "anonymous" on the line; or (3) reveal the author's identity. If the work is "pseudonymoo a work is "anonymous" if that author is not identified on the copies or phonorecords of the work. An author's contribution to a work is "pseudonymous" if that author is identified on the copies or pclude the name of the employee along with the name of the employer (for example: "Elster Music Co., employer for hire of John Ferguson"). "Anonymous" or "Pseudonymous" Work: An author's contribution t for hire." If you have checked "Yes" to indicate that the work was "made for hire," you must give the full legal name of the employer (or other person for whom the work was prepared). You may also in as an instructional text, as a test, as answer material for a test, or as an atlas, if the parties expressly agree in a written instrument signed by them that the work shall be considered a work madeamples: "Music"; "Song Lyrics"; "Words and Music"; "Drama"; "Musical Play"; "Choreography"; "Pantomime"; "Motion Picture"; "Audiovisual Work." 1 SPACE 1: Title supplementary work, as a compilation,likely to look, or under which a document pertaining to the work might be recorded. Nature of This Work: Briefly describe the general nature or character of the work being registered for copyright. Exidual works after the collection title. Previous or Alternative Titles: Complete this space if there are any additional titles for the work under which someone searching for the registration might be or more individual contributions to a collective work, give the title of each contribution, followed by the title of the collection. For an unpublished collection, you may give the titles of the indivnformation you give here. If the work you are registering is an entire "collective work" (such as a collection of plays or songs), give the overall title of the collection. If you are registering one ntifying phrase that could serve as a title), transcribe that wording completely and exactly on the application. Indexing of the registration and future identification of the work will depend on the itificate. Title of This Work: Every work submitted for copyright registration must be given a title to identify that particular work. If the copies or phonorecords of the work bear a title (or an ide. Please keep this statement and refer to it if we communicate with you regarding this application. LINE-BY-LINE INSTRUCTIONS Please type or print using black ink. The form is used to produce the cer indexes, preparation of public catalogs of copyright registrations, and preparation of search reports upon request. NOTE: No other advisory statement will be given in connection with this applicationc record and the examination of the application for compliance with the registration requirements of the copyright code. Other routine uses include public inspection and copying, preparation of public be entitled to certain relief, remedies, and benefits provided in chapters 4 and 5 of title 17, U.S.C. The principal uses of the requested information are the establishment and maintenance of a publi is title 17, U.S.C., secs. 409 and 410. Furnishing the requested information is voluntary. But if the information is not furnished, it may be necessary to delay or refuse registration and you may notother information from the Copyright Office website at www.copyright.gov. PRIVACY ACT ADVISORY STATEMENT Required by the Privacy Act of 1974 (P.L. 93-579) The authority for requesting this information call the Forms and Publications Hotline at (202) 707-9100. Most circulars (but not forms) are available via fax. Call (202) 707-2600 from a touchtone phone. Access and download circulars, forms, and n: To speak to an information specialist, call (202) 707-3000 (TTY: (202) 707-6737). Recorded information is available 24 hours a day. Order forms and other publications from the address in space 9 or. For works first published on and after March 1, 1989, use of the copyright notice is optional. For more information about copyright notice, see Circular 3, "Copyright Notice." For Further Informatiominute segment. The Copyright Notice: Before March 1, 1989, the use of copyright notice was mandatory on all published works, and any work first published before that date should have carried a noticeomplete copy of the motion picture or identifying material. Identifying material may be either an audiorecording of the entire soundtrack or one frame enlargement or similar visual print from each 10- (1) a separate written description of the contents of the motion picture; and (2) for a published work, one complete copy of the best edition of the motion picture; or, for an unpublished work, one c of the first foreign edition. Contribution to a Collective Work: Deposit one complete copy (or phonorecord) of the best edition of the collective work. Motion Pictures: Deposit both of the following: copy (or phonorecord). Published Work: Deposit two complete copies (or one phonorecord) of the best edition. Work First Published Outside the United States: Deposit one complete copy (or phonorecord)pies or phonorecords representing the entire work for which registration is made. The following are the general deposit requirements as set forth in the statute: Unpublished Work: Deposit one complete choreographic works; and (4) motion pictures and other audiovisual works. Deposit to Accompany Application: An application for copyright registration must be accompanied by a deposit consisting of co"by means of any device or process." Works of the performing arts include: (1) musical works, including any accompanying words; (2) dramatic works, including any accompanying music; (3) pantomimes andse Form PA for registration of published or unpublished works of the performing arts. This class includes works prepared for the purpose of being "performed" directly before an audience or indirectly b Form PA b Detach and read these instructions before completing this form. Make sure all applicable spaces have been filled in before you return this form. BASIC INFORMATION When to Use This Form: U