* TODAY’S
DATE:______________
*Referred to TBIC by
_____________________________
**NAME: _________________________________________________________________________________
LAST MIDDLE FIRST
*ADDRESS:
_________________________________________________________________________________
STREET APT.#
CITY:
*HOME
PHONE#____________________ * CELLULAR #____________________________
***E-mail Address _____________________________________________________________
___
MALE ___FEMALE Marital Status: Single___ Married___ Divorced___ Widowed ____
TYPE OF EMPLOYMENT:_____________________________________________________
NAME OF EMPLOYER :__________________________________________________________
STREET___________________________________ SUITE#____________________________
CITY:
WORK PHONE:_______________________________
NUMBER OF INVENTIONS:___________ NUMBER OF PATENTS:_________________
LIST BELOW THE IDEAS OR PATENTS
(NO
DETAILS)
Invention’s Name Process Status: (Concept,
Patent searched, Patented)
(Unless too descriptive)
1.)____________________________________________STATUS:______________________
2.)____________________________________________STATUS:______________________
3.)____________________________________________STATUS:______________________
What kind of assistance would you consider
helpful in getting your idea to the next level?
_______
PATENT SEARCH
_______
PATENT or PROTECTION ASSISTANCE
_______ PROTOTYPE OF INVENTION
_______ FOCUS GROUP FOR EVALUATION PURPOSES
_______ MANUFACTURING AND DISTRIBUTION
_______ COST ANAYLISIS OF MANUFACTURED PRODUCT
_______ MARKETING YOUR PRODUCT TO INDUSTRY
OTHER ( EXPLAIN
)__________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
MEMBERSHIP
It is recommended
that there are four (4) classifications of members:
1. STUDENT MEMBER –
An annual fee of $25.00
Elementary, Middle
School, and High School Students may attend meetings and have access to
seminars if accompanied by Parent or
2. SEMI-ANNUAL MEMBER
– A semi annual fee of $50.00.
This membership
allows the member to enjoy all the benefits that TBIC has to offer for 6
months.
3. ANNUAL MEMBERSHIP-
The Annual fee of $90.00.
Allows a member to enjoy all the benefits that
TBIC has to offer for one full year and includes the Scientific Journal.
4. CORPORATE MEMBER:
An annual fee of $200.00
Corporate members may
have up to 3 individuals to attend meetings and in addition have access to new
products coming out of member inventors before they are marketed publicly.
*Joining as a _______________ member *Date
Joined____________________________
*Method of Payment
*Cash_______ *Check
#___________
Would you like to
have your information included in a future Membership Directory? This directory
will list the talents and skills of members to refer to for needed help.
Please provide your Skills, Talents and a preferred means of contacting
you.
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
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Welcome to the