Partnership Meetings Speaker Interest Form

*First Name

*Last Name

*E-mail Address

*Telephone (spaces/hyphens may be used)

Best Time to Reach AnytimeAMPM

Job Title

Company or Organization

URL

Topic(s) of Interests

Short Description of Topic(s)

*Preferred Partnership Meeting(s) (Select all that apply)
TC 1600 Biotechnology/Chemical/Pharmaceutical Customer Partnership Meeting – Biotechnology and Organic Fields
TC 1700 Customer Partnership Meeting – Chemical and Materials Engineering
TC 2400 Cyber Security Customer Partnership Meeting
TC 2600 Customer Partnership Meeting - Communications
TC 2800 Semiconductor Customer Partnership Meeting - Semiconductors, Electrical and Optical Systems and Components
TC 2900 Design Day - Designs
TC 3600 Business Methods Customer Partnership Meeting - Electronic Commerce, Licensing and Review
TC 3600 & 3700 Customer Partnership Meeting - Transportation, Construction, Agriculture, Mechanical Engineering, Manufacturing and Products
Partnering in Patents - in collaboration with all TCs and AIPLA
No preference

*Preferred Venue(s) (Select all that apply)
Alexandria, Virginia
Dallas, Texas
Denver, Colorado
Detroit, Michigan
San Jose, California
Virtually via WebEx

Additional Comments