Music Publisher's Association PMB 246 1562 First Avenue New York, NY 10028 FORM FOR REPORTING COPYRIGHT VIOLATIONS PURPOSE: This form was created to help compile information to report copyright violations. We want to stress that you shall remain ANONYMOUS. All of the following questions are optional but the more information you provide the easier it is for the publisher to pursue the case. If you choose to be kept abreast of any action taken, provide your name and address under question four. PROCEDURE: The MPA's policy is to bring all information of reported copyright violations directly to the publishers whose works are being infringed. Member publishers are given the option to pursue the infringers directly and/or to have MPA's counsel respond on their behalf. Please fill out this form and mail it to the MPA at the above address. The MPA requests that you provide as much information as possible and send any actual illegal copies of music materials you may have. 1 Where, when and how were the illegal copies discovered? 2 Who are the responsible parties? (i.e. if the illegal copying activity is in a school, provide the name of the school, teacher, principal, and school superintendent) 3 Any relevant history to the situation (Has the issue been addressed with the violators? Is this a first offence or a recurring offender?). 4 Names of parties that wish to be apprised of the action taken against the violators. PLEASE PROVIDE (for each work): 5 The title of the work being illegally copied. 6 The name of the composer and text writer. 7 The publisher. 8 The copyright notice. 9 The product code number.