It was officially released in 2004, as an internet-only single that could be streamed through the band's website, while promotional copies of the single were released on CD. The single also included a cover of the Julian Cope song "World Shut Your Mouth", which was also later released on the "Crooked Teeth" single on Death Cab for Cutie's follow-up album, Plans.
Due to the song's layered instrumentation, "Title and Registration" has been difficult to play during live performances and thus has been performed a variety of ways. All of these involve guitarist Chris Walla switching halfway through the song from lead guitar to keyboards, whilst singer/guitarist Ben Gibbard takes over the guitar part. For the first half of the song, initially, both Gibbard and drummer Jason McGerr used electronic drums in order to replicate the distinctive drum machine sound used at the beginning of the song.
In the band's 2008 tour, Gibbard performed the entire first two verses as lead vocalist, without a guitar or drums; before picking up his guitar as Walla switched to the keyboard. Most recently, Gibbard has kept his electric guitar strapped on for the entirety of the song, but using a shaker as percussion during the song's first two verses.
The video, directed by Patrick Daughters, consists of frontman Ben Gibbard lying on an operating table while undergoing a "surgery" (as done by the other band members) to receive a new heart. Although Ben seems to act calm and has the ability to sing throughout the procedure, he was not given anesthetics. During the surgery, it is shown that Gibbard's chest is simply paper, model organs, and a model rib cage.