WIPLA - Membership

Interested in joinging WIPLA?
Simply fill out and submit the form below, or click here for a printable version.

Full Name:
Business Address:
Telephone:
E-Mail:
Fax:
Residential Address:
List Patent Training, Degrees, Colleges, and Years Graduated:
List Previous Experience:
Registered to practice before the USPTO:
Registration number:
Courts (List Bar of any state and any courts to which admitted):
I hereby apply for membership in the Wisconsin Intellectual Property Law Association as an:
Active Member (info)
Auxiliary Member (info)
Forthcoming will be a check for:
$40 for the initial membership fee and the current year's due; or
$75 for the initial membership fee, current year's dues, and following year's dues. Send checks to: Joe Harcarik Cook Alex Ltd. N6638 Shorewood Hills Road Lake Mills, Wisconsin 53551
I understand this Application, sponsored by two active members, requires approval by the Board of Directors of the Association after notice to the members.
Sponsor One:
Sponsor Two:
Please add any additional comments, questions, or concerns:
Electronic Signature of Applicant