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MEMBER PAYMENT INFORMATION

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SECOND SECTION

To better understand the needs and demographics of our membership, please fill out the following section. Please OMIT any question you feel uncomfortable with We will NOT SHARE this information with anyone. We plan to use it as a broad general overview to pick out speakers of interest or to answer questions relating to the overall meetrics of our group.

Gender

Business Name (if applicable):

Is your company a minority-owned business?

Age:

Income in thousands:

Are you a -- Please pick all that apply.

As a professional, would you like to submit a FREE profile for our resources page?

THIRD SECTION - FOR INVENTORS ONLY

Do you consider yourself a:

How many patents do you already have (including those owned by other companies?

Please list your 10 most recent patent numbers:

Do you have products for sale?

How many products do you have for sale?

Would you like to submit a FREE profile and list your products on our Members Page?

YOUR MOST RECENT INVENTION

It seems like we are all working on several inventions at any given moment. Please think of the invention at the top of your list for the following questions:

Regarding prototypes, do you have a:

Is your prototype covered by:

What type of product is it?

If you chose "other" for product type, please specify:

What industry is your product in?

If you chose "other" for product industry, please specify:

SUBJECT INTERESTS

What types of presentations would you like to see at the meetings?

If you chose "other presentations" for subject interests, please specify:

Would you like to give a member presentation?

ELECTRONIC SIGNATURE

We are a 501 (C) (3) non-profit organization, dedicated to the advancement of the independent inventor through the use of education, motivation and collaborative support.

We provide a wealth of information through our newsletter, handouts, website, direct discussions and speakers.

However, inventing is a business and it is up to you to determine whether any of that information is pertinent to your own project or to decide if you want to pursue a relationship with any individual you came in contact with or through the organization, for which we cannot be held liable. Please Note: That disclosing the proprietary information regarding your invention to anyone without a Patent Application, Confidentiality Agreement or Non-Disclosure Agreement in place constitutes a Public Disclosure which may cause you to lose your right to patent your invention in most countries and leaves you with one year to file an full utility application in the USA.

Electronic Signature: by signing or typing in your name below you are stating that you have read and understood the waiver above.

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