This application is the convenience of those who wish to become MEMBERS and/or RECEIVE our monthly NEWSLETTER.
Please fill out the application completely and send your check or money order to:
EDISON INVENTORS ASSOCIATION, P.O. Box 07398, Fort Myers, FL 33919 .
All fees listed apply to the Continental United States. Applicants outside this area will assume additional costs.
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[ ] YES, I would would like to become a new member or renew. Individual : __ $ 25 Annual Renewal __ $ 35 New Members ________ Total $
Family : __ $35 Annual Renewal __ $55 New Family ________ Total $
[ ] Business/Corporate $ 100 ( first two application fees waived then $10 per person. Inquire about special benefits.) I understand annual renewal is the first day of March of each year. Members joining all other times will pay for a full year and receive a proration on the next renewal notice to extend the current membership through February of their second membership year. [ ] I do not wish to join at this time but would like to receive the newsletter. Enclosed is $ 15 for a one year subscription. [ ] I would like to make a donation to the Bernard A. Cousino Memorial Fund. $ __________________ |
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Name _____________________________________ Address ____________________________________ City _______________________________________ State ________________ Zip _______________ Preferred phone contact ____________________ E-mail ________________________________ Print clearly the name or names for your Official ID Badge: ( Print name as you wish it to appear) ______________________________________ ______________________________________
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OFFICE USE ONLY
Paid $ _________________ [ ] Cash [ ] Check # _____________
[ ] Please send me a copy of
"A Guide to Charitable Gift Planning at the Edison Inventors" Office Phone __________________________
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Optional Information
Reason for joining:
[ ] for fun
[ ] for help
[ ] to offer help (area of expertise) _________________________________________________
What areas are you interested in at this time:
[ ] Patent Protection
[ ] Domestic Marketing
[ ] International Marketing
[ ] Prototyping
[ ] Raising Capital
[ ] Investing in New Product Development
[ ] Manufacturing [ ] Business Planning [ ] Other
Are you currently interested in:
[ ] presenting your product to members in a Show & Tell
[ ] making a presentation to the members . Subject : _________________________________
[ ] serving in some capacity to help the organization: _________________________________
[ ] interested in helping with the Young Inventors Program