NEW MEMBER APPLICATION

 

* TODAY’S DATE:______________  *Referred to TBIC by _____________________________

 

**NAME:  _________________________________________________________________________________

                  LAST                                  MIDDLE                              FIRST

 

*ADDRESS:  _________________________________________________________________________________

                        STREET                                                                                             APT.#

 

CITY:  _______________________  STATE: __________________  ZIP:___________________

 

*HOME PHONE#____________________     * CELLULAR #____________________________

 

***E-mail Address _____________________________________________________________

 

___ MALE ___FEMALE    Marital Status:  Single___ Married___ Divorced___ Widowed ____

 

TYPE OF EMPLOYMENT:_____________________________________________________

 

NAME OF EMPLOYER :__________________________________________________________

                   

STREET___________________________________      SUITE#____________________________                                                    

 

CITY:________________________  STATE:__________________________    ZIP:___________

 

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 Mentor.

 

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 Tampa Bay Inventors Council!