OKLAHOMA INVENTORS CONGRESS

** A Non-Profit Educational Corporation **

APPLICATION FOR MEMBERSHIP

                                                   Date

TO THE MEMBERSHIP DEVELOPMENT COMMITTEE:

     I, the undersigned, do hereby make application for membership as a Regular Member of the 
Oklahoma Inventors Congress and enclose herewith a check or money order in the amount of 
$25.00 for New Membership $15.00 for Renewal dues for the calendar year 2007 2008 2009 2010 . I do so with the 
understanding that if for any reason this application is rejected, it will be returned to me, at the 
address here below written, accompanied by a reimbursement of the dues payment and a letter 
explaining the reason(s) for such  rejection.

     If accepted for membership, I hereby promise to abide by the Constitution and by laws of the 
organization, and assist, to the  best of my ability, knowledge and expertise, to further the 
advancement of the creative arts and the recognition of the  contributions of the independent inventor.

                            _____________________________________   
                                            Signature of Applicant   
                                        New Member ($25.00)    Renewal ($15.00)

                      APPLICANT INFORMATION SECTION
                              Please enter an "X" in the appropriate box(es)

I am interested in:  
Creative Thought    Idea Development    The Patent Process    Helping Others

I presently have:   
An idea, which may result in a new invention     An invention     The desire to invent

My idea/invention is:    
Mechanical    Electrical    Chemical    A Process    Horticultural    
Other  

The status of my idea / invention / desire is:
Idea Only               Sketch(s)              Some Drawings              Full Drawings  

I have made or constructed:
No Model       A Non - Working Model         A Working Prototype

My idea is protected by:      
Secrecy    A Filed Disclosure Document   A Filed Patent Application   U.S. Patent(s)   
Foreign Patent(s)      U.S. Patent Number(s)

I need assistance in: 
Idea Development  Prototype Development Patent Research  Marketing  Venture Capital
Patent Application  Manufacturing   Business Planning   Engineering   Liability Insurance  

I have expertise in the following field(s):  

I can assist other members with:

If accepted for membership, I will be willing to serve on committee assignments at the: 
Local Chapter Level   State Level   National Level   International Level    No Committees  

My full name is: (Please Print or Type)

My mailing address is:

City   State  Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, D.C. West Virginia Wisconsin Wyoming   Zip Code 

E-Mail Address  

I may be reached by telephone at: 

during the Day   or    Evening

*The Oklahoma Inventors Congress is a member of the United Inventors Association of the United States of America, is an Affiliate of The Alliance for American Innovation, Inc., and is recognized by the World Intellectual Property Organization (WIPO) of Geneva, Switzerland.  
SPONSORING AGENCY: THE OFFICE OF THE GOVERNOR, DEPARTMENT OF COMMERCE ©OIC 1997