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Pittsburgh Intellectual Property Law Association


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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


P
ittsburgh Intellectual Property Law Association

700 Koppers Building - 436 Seventh Avenue
Pittsburgh, PA 15219
(412) 227-3028