Reconsideration Request Form Title (required) Author(s): (required) Publisher (if known): Request Initiated by: (required) Telephone: (required) Address: (required) City: (required) Zip: (required) Is complainant representing self or representing an organization: (required)Representing self Representing organization Organization's name, if complainant is representing an organization: Did you read/view/listen to the entire work? (required)Yes, I read/view/listen to the entire work No, I did not read/view/listen to the entire work What concerns do you have about this work? Please be specific (i.e. cite pages, timestamps for AV materials, scenes, lyrics, etc.) (required) What action would you like to see taken regarding this work? (required) In its place, what work of equal quality would you recommend to convey of the subject treated? (required) If you have any supporting documents to your claim, upload them in a .pdf format Your Signature (required) Confirm e-Signature Review Electronic Records and Signatures Policy (required)Read our Electronic Record and Signature Disclosure I agree to use electronic records and signatures There was a problem saving your submission. Please try again later. Please wait while your submission is being saved... Submitting...Submit Thank you, your submission has been received.
