COPYRIGHT USER DETAILSRegistered Name:(Required) Name Surname Registration/Identity Number:(Required) VAT Number: Physical Address(Required) Street Address City State / Province / Region ZIP / Postal Code CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Postal Address: Email Address:(Required) Enter Email Confirm Email Contact Number:(Required)Website APPLICANT DETAILSEmail Address: Enter Email Confirm Email Contact Number:WORK TO BE USEDCreator(s):(Required) Full Title:(Required) Year: Publisher: Country of Origin of the Work To Be Used:(Required) ISBN/ ISSN/ other identifiers of work to be used: Number of pages in the work to be reproduced: Specific page numbers to be reproduced: DETAILS OF WORKIntended Use:(Required)PERFORMING DRAMATIC WORKREPRODUCING VISUAL ART WORKREPRODUCING LITERARY WORKADAPTING DRAMATIC, VISUAL ART OR LITERARY WORKDetails of intended usage:(Required) PERFORMING DRAMATIC WORKNumber of intended performances:Proposed performance dates: Proposed performance venue(s): Seating capacity of the venue(s): Proposed ticket price range: Ticketing service to be used (if any): Paid advertising details (if any): Kind of performance:ProfessionalAmateurOtherIf other, specify details of type of performance: Details of cast members:Grade: Age: Language of the performances will be in: REPRODUCING VISUAL ART WORKThe title of copyright user’s work: ISBN/ISSN number of copyright user’s work: Size of reproduced image thumbnail in copyright user’s work (e.g. 1/4 page or less / 1/2 page of less / full page): Digital print run details of copyright user’s work (including website details): Physical print run details of copyright user’s work: Language of copyright user’s work: Territory of copyright user’s work: Year of publication of copyright user’s work: Is the copyright user’s work intended for trade or education purposes?TradeEducationLength of time of intended usage: REPRODUCING LITERARY WORKTitle and ISBN ISSN/identification number of copyright user’s publication: Physical print run details of copyright user’s work: Year of publication of copyright user’s work: Digital print run details of copyright user’s work (including website details): Language of copyright user’s work: Length of time of intended usage: Is the copyright user’s work intended for trade or education purposes?TradeEducationCourse of Study for which the copies are to be made: Name of academic staff member teaching the course of study: If the reproduction is made as a single item handout, or for the compilation of a course pack; how many handouts or course packs will be made? If the reproduction is to be placed in the copyright user’s short loan library collection, how many copies will be made for the collection and how many students are enrolled for the relevant course of study? If the reproduction is made by means of a transient electronic copy, how many students are enrolled in the course of study? ADAPTING DRAMATIC, VISUAL ART OR LITERARY WORKTitle of copyright user’s work: ISBN/ ISSN/ identification number of copyright user’s work: Size of work to be adapted: Physical print run details of copyright user’s work: Digital print run details of copyright user’s work (including website details): Year of publication of copyright user’s work: Language of copyright user’s work: Territory of copyright user’s work: Is the copyright user’s work intended for trade (cinema) or education purposes?EducationTrade (Cinema)Length of time of intended usage: Total cinematographic work budget: Cinematographic work distribution: Intended year of cinematographic work principal photography: HiddenConsent and SecurityConsent(Required) By engaging with DALRO you acknowledge that DALRO needs to process your personal information as necessary and you are deemed to consent to such processing.(Required)CAPTCHA