To register, mail this form with payment by check or credit card to Intellectual Property Owners (IPO), 1255 23rd Street, NW, Suite 850, Washington, DC 20037, or FAX this form and credit card information to (202) 466-2893.
 

Name _____________________________________________________________________________

Organization ________________________________________________________________________

Street _____________________________________________________________________________

City, State, Zip ______________________________________________________________________

Phone_____________________________________________________________________________

Fax _______________________________________________________________________________

E-mail_____________________________________________________________________________

Conference Fee: $125 per person

Make conference checks payable to: Intellectual Property Owners

Credit Card Payment: All faxed registrations MUST be made by credit card payment.

Circle the Appropriate Credit Card Type :

o MasterCard
o Visa
o Diner's Club
o American Express

Card number________________________________________________________________________

Expiration Date ______________________________________________________________________

Signature___________________________________________________________________________