×

Name:

Adress:

Country: USA Albania Algeria American Samoa Andorra Angola Anguilla Antigua Antilles Argentina Armenia Aruba Australia Austria Azerbaijan Azores Bahamas Bahrain Bangladesh Barbados Barbuda Belgium Belize Belorus Benin Bermuda Bhutan Bolivia Bonaire Bosnia-Hercegovina Botswana Br. Virgin Islands Brazil Brunei Bulgaria Burkina Faso Burundi Caicos Island Cameroon Canada Canary Islands Cape Verde Cayman Islands Central African Republic Chad Channel Islands Chile China Colombia Commonwealth of Ind Congo Cook Islands Cooper Island Costa Rica Cote D'Ivoire Croatia Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador England Equatorial Guinea Estonia Ethiopia Fiji Finland France French Guiana French Polynesia Futuna Island Gabon Gambia Georgia Germany Ghana Gibraltar Greece Grenada Grenland Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Holland Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland, Northern Ireland, Republic of Isle of Man Israel Italy Ivory Coast Jamaica Japan Jordan Jost Van Dyke Island Kampuchea Kazakhstan Kenya Kiribati Korea Korea, South Kosrae Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Madeira Islands Malagasy Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Nevis Nevis (St. Kitts) New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Norman Island Northern Mariana Island Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Ponape Portugal Qatar Reunion Romania Rota Russia Rwanda Saba Saipan San Marino Sao Tome Saudi Arabia Scotland Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka St. Barthelemy St. Christopher St. Croix St. Eustatius St. John St. Kitts St. Lucia St. Maarten St. Martin St. Thomas St. Vincent Sudan Suriname Swaziland Sweden Switzerland Syria Tahiti Taiwan Tajikistan Tanzania Thailand Tinian Togo Tonaga Tonga Tortola Trinidad and Tobago Truk Tunisia Turkey Turkmenistan Turks and Caicos Island Tuvalu U.S. Virgin Islands Uganda Ukraine Union Island United Arab Emirates Uruguay United Kingdom Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands (Brit Virgin Islands (U.S. Wake Island Wales Wallis Island Western Samoa Yap Yemen, Republic of Yugoslavia Zaire Zambia Zimbabwe Kosova Afghanistan Libya Eritrea

Phone:

Email:

By checking the following boxes, I state UNDER PENALTY OF PERJURY that::

I have a good faith belief that the disputed use of the copyrighted material is not authorized by the copyright owner, its agent, or the law (e.g., as a fair use).

I am the owner, or authorized to act on behalf of the owner, of the copyright or of an exclusive right under the copyright that is allegedly infringed.

The information in this notice is accurate.