MEMBERSHIP APPLICATION - email to hskillman@asoi.org or mail to:
American Society of Inventors
P.O. Box 58426
Philadelphia, PA 19102
(215) 546-6601


Last Name:_____________________ First Name:_________________ M.I.:___ Title:_______


Preferred Mailing Address (ASI Mailings):   __ Home    __ Business
I prefer to receive information via:        __ Email   __ Postal Mail  

Addr1: _____________________________    Birthdate (yy/mm/dd): 19___ / ___ / ___ 

Addr2: _____________________________    Phone (Home): (____)_____________________ 

City:  _____________________________    Phone (Business):(____)____________________ 

State, Zip  ____________________        E-Mail:______________________________ 

(Note: Your profile will soon be available to update online via our www.asoi.org web site)
___________________________________________________________________________________
(Note: Payment can be made electronically via PayPal.   EMAIL this membership application to Henry Skillman at hskillman@asoi.org and send a PayPal payment to the PayPal account hskillman@asoi.org or use one of our links to make this payment.)

_____          I am applying for a new Full Membership.
               Enclosed is my payment of $49.00 for the first year

_____          I wish to apply for a full three-year membership.
               Enclosed is my payment of $99.00

_____          I wish to renew my annual membership.
               Enclosed is my payment of $45.00


__________________________                   ______________________________________
 Date                                           Signature
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Please list the following information:

A. What is your area of expertise?



B. Are you willing to share your experiences with others?



C. Are you currently working on an invention?  If so, please indicate the legal status and general subject area of the invention.



D. Do you have any patents?  If so, please list the patent numbers, and a brief description for each.



E. How did you hear about us?  What do you expect to get from membership?