Work Registration Form

Name

First name *

Last name *

Email address *

This is the email address of the person filling the form

Work title *

Alternate title

Artiste *

Duration (Mins and Secs) *

Example 4.23

Release date *

Month

Day

Year

PLEASE INDICATE WRITERS/PUBLISHERS NAMES AND SHARE OF ROYALTIES

	Name of Writer or Publisher	Designation (See description)	Performing Share (%) This column MUST total 100%	Mechanical Share (%) This column MUST total 100%	IPI Number or Society of Co-writers, Composers or Publisher
Writer/Publisher 1
Writer/Publisher 2
Writer/Publisher 3
Writer/Publisher 4
Writer/Publisher 5
Writer/Publisher 6

"C" for Composer (Music Only), "A" for Author (lyrics), "CA" for Composer and Author, "Arr" for Arranger of PD, "E" for Original Publisher, "SE" for Sub-Publisher | "Performing" column MUST total 100% | "Mechanical" column MUST total 100%

Any other information you need to tell us?

Tick Box For purpose if otherwise of registration

Amended Registration

Dramatical Musical Work

Authority not given for First recording

Tick Box for Preferred US Licensing Society *

ASCAP

BMI

SESAC

Publishing: Date of Agreement

Month

Day

Year

Valid Thru

Month

Day

Year

Publishing Territory

Attach Agreement

Files must be less than 1 MB.
Allowed file types: txt rtf pdf doc docx.

Attach an MP3 copy of work *

Send us an mp3 copy of the song.
Files must be less than 20 MB.
Allowed file types: mp3.

IF BASED ON PUBLIC DOMAIN (PD) WORDS AND/OR MUSIC

Title of PD work

PD Writers

Select One

Arrangement of PD music and new words

Adaption of PD words and new music

Arrangement of PD music and adaption PD words

Arrangement of PD music only (instrumental)

Other

If other (give details)

IF AN AUTHORISED TRANSLATION OR AUTHORISED USE OF COPYRIGHT WORDS

If includes (select one)

A melody

Sampling

Please attach authorization

Files must be less than 1 MB.
Allowed file types: txt rtf pdf doc docx.

Title of original work

Original Writers