INVENTORS TRUST

Forum Membership Application Form

Please Print And Forward With Your Payment to Inventors Trust, PO Box 19 655, Avondale, Auckland 1230.

Title: (please circle) Mr / Mrs / Ms / Dr / Prof. Family Name: _____________________________________________
First Name: ________________________ Preferred Name (if different): ___________________________________ Residential Address: ____________________________________________________________________________ Postal Address (if different from above): _____________________________________________________________
Home Phone: _________________ Work Phone: ________________ Mobile Phone: _________________________
Fax Number: ____________________________ E-Mail Address: ________________________________________ Occupation: __________________________________________________________________________________ Qualifications: _________________________________________________________________________________ Main Interests: ________________________________________________________________________________ ____________________________________________________________________________________________

INVENTING EXPERTISE (please tick any categories that may apply to you):

Information supplied will be entered into our database. Please mark with an asterisk * any information that you DO NOT wish to be made available to other members

Subscription Fees:
1 Regular members - once only registration of $50 with $48 annual subscription fee
                                                                                                                    - 1st year fee = $98
                                                                                                                 Then each year = $48
1 Students/rural members- once only registration of $10 with $48 annual subscription fee
                                                                                                                    - 1st year fee = $58
                                                                                                                  Then each year = $48
1Associate members – once only registration of $10 - must be associated with a partner, spouse, family member who is a      current, full-fee paying member. NB. Associate households will receive one newsletter only.
1Corporate Membership – once only registration of $250 with $250 annual subscription fee
    Corporate members may receive up to 5 newsletters per month.                - 1st year fee = $500
                                                                                                                 Then each year = $250
Cheques are payable to INVENTORS TRUST. Donations are gratefully accepted and are tax deductible.
Payment Attached: $………………………. Cheque / cash (please circle)

OATH OF CONFIDENTIALITY
Note that all monthly meetings of the Inventors Trust Forum are notified in the newsletter mailed out to members. Each meeting is therefore a private meeting and will not be regarded as "public disclosure" by parties wishing to effect the patentability of an idea or product. To further reinforce the confidential nature of the meetings, members MUST sign the declaration below, and visitors to any meeting must also sign the same oath contained in the Visitors Book to thereby become a recorded ‘Invitee’ under oath. The Visitors Book is kept in the archives.

THE DECLARATION
I do hereby agree to keep ALL information disclosed during an Inventors Trust or IT Forum meeting STRICTLY CONFIDENTIAL to the meeting and agree not to discuss further or use such information at any time, recognising that this may result in damages to the parties concerned, unless prior written consent has been obtained from the parties involved. If accepted as a member I will abide by the Inventors Trust Forum rules.

SIGNED: ________________________ DATE: __________________________

WITNESS: _______________________DATE: __________________________

DISCLAIMER
While all care is taken to create a confidential meeting, each attendee discloses sensitive information at their own risk. While helpful advice is given in good faith, we strongly recommend you seek professional advice where appropriate.

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