CIP Application to Participate
 

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Instructions * indicates required field


U.S. Publisher

 

Publishing House:    *
Street/P.O. Box:    *
City/Town:    *  State:   Zip code:  -
Phone:   ( )    *    Fax:  ( )  
Email:    
Homepage:  


Senior Officer

 

Last Name:    *  First:  *  Middle:
Job Title:  
Phone:   ( )    *    Fax:  ( )  
Email:  

 

    If address for Senior Officer is different from Publisher, click here.
    For registration of a non-US Senior Officer, click here.


Principal Contact

 

Last Name:    *  First:  *  Middle:
Job Title:  
Phone:   ( )    *    Fax:  ( )  
Email:  

 

    If address for Prinicipal Contact is different from Publisher, click here.
    For registration of a non-US Principal Contact, click here.


Imprints

 

    Name of imprint as it appears on the title page:    
    Do not enter book title(s) here.   ISBN Prefix:  
1.      
2.      
3.      

 

    If you will request CIP Data for additional imprints, click here.


Last three titles published

 

Title:   
Author:   
ISBN:      Number of copies printed: 

 

Title:   
Author:   
ISBN:      Number of copies printed: 

 

Title:   
Author:   
ISBN:      Number of copies printed: