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:_______


Note:  All of our communications are electronic. There is an additional fee for mailing of $10 per year. (USA only)   

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

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

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

State, Zip  ____________________        E-Mail:______________________________ 

___________________________________________________________________________________
(Note: Payment is preferred to be made electronically via PayPal.   Just 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 --- see the Join or Renew pages of our web site at www.asoi.org .)

_____          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, OR  _____ I wish to renew for three years.
               Enclosed is my payment of $120.00

_____          I wish to renew my annual membership.
               Enclosed is my payment of $49.00

_____          I don't have email and would like my newsletters mailed through Postal mail for an additional $10.00/yr.


__________________________                   ______________________________________
 Date                                           Signature
___________________________________________________________________________________

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?