Opt out of proceeding

Docket *

Opt-out keycode *

Respondent name or organization *

Respondent's address

Street address *

Street address 2

City *

State *

Postal code *

I certify under penalty of perjury that I am the respondent, the legal counsel, or an authorized representative of the respondent, identified in this claim and listed above. If I am the legal counsel or authorized representative of the respondent, I have been directed and authorized by the respondent to opt out of this proceeding.

I affirm that the respondent identified in this claim and listed above is opting out of this proceeding and will not appear before the Copyright Claims Board with respect to this claim.

Please certify your identity *

I certify that I am the respondent identified in the claim.

I certify that I am the legal counsel or an authorized representative of the respondent identified in the claim.

Full name *

Email for receipt *

Signature

Your typed signature, affirming your desire to opt out of the proceeding and your authority to opt out on behalf of the respondent, is required. Please enter your full name below. *

Please check the box to proceed *

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