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ENROLMENT FORM

To the President - The Institute of Inventors 19/21/23 Fosse Way - Ealing, London W13 OBZ
Tel.: #44 (0)20 8998 6372   Fax: #44(0)20 8998 1275   e-mail: mikinvent@aol.com

Please accept my membership application and joining fee of £120 * (attached or)
charged to my Maestro/Debit/Amex/Visa/Master Card No.
Valid From:               Valid to end:                  Security No.                 Issue No.              

SIGNED ................................................................. DATE .....................................

Full Name: ...............................................................................................................

Address: ..................................................................................................................

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Post code: .............................................Country: ................................................

Tel: (home): ........................................Tel: (work): ................................................

Mobile: ...........................................................

Date of birth: .......................................................................................................

Occupation.............................................Qualifications (if any): .............................

 List below titles of inventions (if any give patent numbers and dates )

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CONDITION OF MEMBERSHIP : It is a condition of membership that Members have
complete confidence in the honesty and integrity of the President,
and all Staff and Committees appointed by him.
Membership  is not an automatic guarantee for success - No Refunds.                                 
*Overseas Membership £200 or US $300
Annual Renewal Fee £40. (Overseas £60 or US $80).