| Submit an Account about Witnessing: Copyright Transfer Form
___________________________[Print Name] ________________
of
_____________________
_____[Print address]______________,
(the “Assignor”)
hereby assigns and transfers to Kaethe Weingarten,
Ph. D., of 82 Homer Street, Newton, MA 02459,
her successors and assigns, all his/her right, title,
and interest to the work entitled
_____________________________________
[Name of Witnessing Account]_______________________________________
(the “Work”),
including copyright and derivative rights thereto and
any statutory copyright, together with the right to secure
registrations, renewals
and extensions of such copyright throughout the world,
for
the full term of said copyright or statutory copyright
and any renewal or
extension of same that is or may be granted throughout
the world.
Date: _____________________________________
By: [Sign Name]____________________________
[PrintName]________________________________
Author/Assignee
Date: _____________________________________
By: [Sign Name]____________________________
[PrintName]________________________________
Author/Assignee
Note: If more than one author all authors must sign the
same form or each must sign a separate form.
PLEASE RETURN A SIGNED ORIGINAL COPY OF THIS FORM TO:
Kaethe Weingarten, Ph.D.
The Witnessing Project
82 Homer Street
Newton, MA 02459
Fax: 617-332-2522
(A fax is acceptable, but the original must follow)
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