Make Check payable to IANE for $40
Annual dues (expiration date will appear on your newsletter
mailing label).
(Please print clearly)
Today's Date: _____________________
Name: ___________________________________
Address: _________________________________
City ____________________________________
State: _____ ZIP: ________________
Tels: (Home) __________________________ (Work) _____________________________
E: Mail _________________________ WEB SITE: (URL) _________________________
Circle One:
Yes I give permission to list the following information for inclusion in the Member Profile Pages of the IANE website, accessible to members only. I may or add or delete information at any time through the Member Profile Coordinator.
No I do not wish to be listed on the Member Profile Pages at this time.
___________________________________________________
Signature Date
Willing to be contacted by other members? (Circle one) Yes No
Preferred means of contact: (Circle one)
E-Mail Phone (contact hours)________________________
All skills, interest and hobbies may be useful to other inventors. Please give as much detail as possible but be careful of disclosing unprotected inventions.
Current or Most Recent Occupation/Skill:
Past Experiences/Occupations/Skills:
Hobbies/Sports:
Other Interests:
In what areas have you already invented/are no longer interested in and are willing to talk about? Any areas you have dabbled in/worked on in the past and have expertise and are willing to share information?
What are you working on that you would like help from other members?
Patents?
Are you willing to collaborate with other members? (Circle one) Yes No
Do you run a business useful to inventors?
Please Explain.
Do you want us to link to any of your business materials or website(s)?
Are you available to offer limited free coaching to other members?
What are your specialty areas?
Other Background: