Exhibit/Company _______________________________________________________________________
Contact ______________________________________________________________________________
Title_________________________________________________________________________________
Address______________________________________________________________________________
City, State, Zip _________________________________________________________________________
Phone Fax ____________________________________________________________________________
E-mail ________________________________________________________________________________
Patent Number(s) of device(s) to
be submitted: _________________________________________________
__________________________________________________________________________
Special electrical or other requirements:
_______________________________________________________
__________________________________________________________________________
Name(s) and title(s) of persons
to be present during public hours of the exhibition: ___________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Each of the following must be included with this form for the application to be considered:
- a copy of the patent
- a one page overview of the invention
- a description of the exhibit, including photographs
and drawings; and
- a photograph of the inventor