Copyright Song Registration Form

COPYRIGHT SONG REGISTRATION FORM

This Copyright Song Registration Form (the "Form") is entered into as of by and between Songwriter Name: and Representative/Publisher Name: . The parties agree as set forth below.

RECITALS

WHEREAS, the Songwriter is the author and owner, or an authorized agent of the owner, of certain musical composition and/or sound recording described below; and

WHEREAS, the Representative/Publisher will prepare and submit a copyright registration claim, and may act as agent to receive correspondence and deposits on behalf of the Songwriter in accordance with the instructions set forth in this Form; and

WHEREAS, the parties desire to record certain particulars of the work and to authorize submission of required deposit material for the purpose of obtaining or maintaining copyright protection;

NOW THEREFORE, in consideration of the mutual covenants herein and other good and valuable consideration, the receipt and sufficiency of which are acknowledged, the parties agree as follows:

1. DEFINITIONS

"Work" means the musical composition and/or sound recording identified in Section 2. "Claimant" means the person or entity asserting authorship or ownership in the Work. "Deposit Materials" means copies or phonorecords, as applicable, delivered for the purpose of registration.

2. REGISTRATION DETAILS

Song Title:

Alternate/Working Title(s):

Type of Work: Musical Composition Sound Recording Lyrics

Name(s) of Author(s) and Contribution Percentage(s):

Date of Completion:    Date of First Publication (if applicable):

Territory of First Publication: ISWC/ISRC or Other Identifiers (if any):

3. DEPOSIT MATERIALS

4. AUTHORIZATION TO SUBMIT

The Songwriter hereby authorizes the Representative/Publisher to prepare, execute and submit the copyright registration claim and to receive correspondence and deposit materials on behalf of the Songwriter. Representative/Publisher shall act only in accordance with the instructions provided in this Form or as subsequently provided in writing by the Songwriter.

5. FEES AND PAYMENT

Registration Fee Responsibility:

Fee Amount to be Paid: $    Payment Method:

6. WARRANTIES AND REPRESENTATIONS

The Songwriter represents and warrants that: (a) the information provided in this Form is true, complete and correct to the best of the Songwriter's knowledge; (b) the Songwriter is the sole author or has the authority to act on behalf of the author(s); (c) to the extent applicable, no assignment, lien, license or other encumbrance exists that would prevent registration or the grant of the rights identified in this Form without the consent of the claimed owner; and (d) any co-authors and rights holders are listed and have consented to this submission as required by applicable law.

The Representative/Publisher warrants that it will exercise reasonable care in preparing and submitting the registration and in handling deposit materials, but does not warrant the outcome of any registration proceeding.

7. INDEMNIFICATION

Each party shall indemnify and hold harmless the other party from and against any and all claims, liabilities, losses, damages, costs and expenses (including reasonable attorneys' fees) arising from any breach of the foregoing warranties and representations or from false or fraudulent statements made by the indemnifying party in connection with the registration.

8. NOTICES

All notices, requests and other communications required or permitted under this Form shall be in writing and shall be delivered to the addresses set forth above or to such other address as either party shall designate in writing.

9. AMENDMENTS; WAIVER; COUNTERPARTS

This Form may be amended only by a written instrument signed by both parties. No waiver of any provision of this Form shall be effective unless in writing signed by the party against whom the waiver is asserted. This Form may be executed in counterparts, each of which shall be deemed an original and all of which together shall constitute one and the same instrument.

10. GOVERNING LAW; ENTIRE AGREEMENT; SEVERABILITY

This Form shall be governed by and construed in accordance with the laws of the state specified below. This Form constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous understandings and agreements. If any provision of this Form is held invalid or unenforceable, the remaining provisions shall continue in full force and effect.

Governing Law State:

11. CERTIFICATION

The undersigned certify under penalty of perjury that they are authorized to execute this Form, that the information contained herein is true and correct to the best of their knowledge, and that they understand that false statements may give rise to civil or criminal liability under applicable law.

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