|
APPLICATION FOR MEMBERSHIP
Name: _______________________________________________________________
Home Address: ________________________________________________________
Principal Office Address: _________________________________________________
(include telephone and fax numbers)
TO THE BOARD OF MANAGERS:
I hereby apply for membership in the Pittsburgh Intellectual Property Law Association as an
Honorary Member
Active Member
Associate Member.
Bar Admissions:_______________________________________________________
USPTO Registration No.:________________________________________________
Nature of Legal Practice: ________________________________________________
__________________________________________________________________
Signature:_____________________________________________________________
Date:_________________________________________________________________
ENDORSEMENTS:
(Add endorsements here or attach separate letters of two members of the Association.)
I endorse the above individual for membership in the Pittsburgh Intellectual
Property Law Association:
________________________ __________________________
Date Endorser
________________________ __________________________
Date Endorser
DUES:
Honorary – Exempt
Active - $50.00
Associate - $15.00
Student - $10.00
Please enclose first year's dues and mail to:
Executive Secretary
Pittsburgh Intellectual Property Law Association
c/o Nora Ann Pastrick
700 Koppers Building
Pittsburgh, PA 15219-1818
|