diff --git a/www/conservancy/templates/assignment/assignment_form.html b/www/conservancy/templates/assignment/assignment_form.html
new file mode 100644
index 00000000..ed2a07a9
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+++ b/www/conservancy/templates/assignment/assignment_form.html
@@ -0,0 +1,38 @@
+{% extends "base_conservancy.html" %}
+{% block category %}Copyright Assignment{% endblock %}
+{% block outercontent %}
+  <style>
+   label { display: block; }
+   input, textarea, select {
+     width: 25rem;
+     padding: 0.25rem;
+     border-radius: 2px;
+   }
+   input[type=checkbox] { width: auto; }
+   span[class=helptext] {
+     display: block;
+     font-size: 12px;
+     font-style: italic;
+     color: #666;
+   }
+   #id_place_of_residence {
+     height: 5rem;
+   }
+  </style>
+  <h1>Copyright Assignment</h1>
+
+  <div class="mw7">
+    <p>Thank you for considering assigning your copyright to the Software Freedom Conservancy. Your assignment helps us enforce copyright on your behalf.</p>
+
+    <p>Please complete the following form and we will prepare the appropriate paperwork. You will receive a PDF form to sign and be witnessed by a public notary.</p>
+  </div>
+
+  <form action="." method="post" class="mw7">
+    {% csrf_token %}
+    {{ form.as_p }}
+
+    <p><em>Please be aware that some employment agreements explicitly transfer copyright ownership to the employer. We recommend you review your recent employment agreements for such clauses.</em></p>
+
+    <p><button type="submit" class="ph3 pv2">Next</button>
+  </form>
+{% endblock %}