National Patent Application and Drafting Competition

Drafting Competition Registration
Approved for use through 11/30/2020. OMB 0651-0032
U.S. Patent and Trademark Office; U.S DEPARTMENT OF COMMERCE
Under the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number.

REGISTRATION DECLARATION
FOR UTILITY

□

Team#
Filing Date

PATENT APPLICATION
DRAFTING COMPETITION

Submitted With
Initial Filing

OR

□

First Coach/Contact

Submitted After
Initial Filing

email or phone
Second coach (if any)
email or phone

,J

(Name of the team or school, and name of the invention)

As a below named student team member, I hereby declare that:

•
•
•
•
•
•
•

The attached application was created and written by the students listed below .
I am enrolled, on a full-time or part-time basis, in a degree program at a law school.
I am/was enrolled at the institution during the 2019-20 academic year .
The program is not an advanced degree in law .
If a registered patent practitioner, my patent registration number was issued after
January 1, 2017.
I have not been admitted or licensed to practice law in any jurisdiction .
I am not a current employee of the USPTO .

I hereby acknowledge that any willful false statement made in this declaration is punishable by
removal from the 2020 National Patent Application Drafting Competition.

Direct all
correspondence to:

Name oleoacfi
Email Address
City

State

Country

l elephone

[Page 1 of 3]
If you need assistance in completing the form, email [email protected].

PTO/AIA/02 (Drafting Competition)
Approved for use through 11/30/2020. OMB 0651-0032
U.S. Patent and Trademark Office; U.S DEPARTMENT OF COMMERCE
Under the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number.

Registration - Utility Patent Application Competition

REMINDERS:
The team members listed below must represent this school at each phase of the Competition,
including but not limited to, search, preparation of the written patent application and appearance(s)
at the regional and national phases of the Competition to give the presentation(s). Should a
student have to individually withdraw from the Competition, the remaining team members may
choose to continue in the Competition (if the team originally comprised three or four competitors) or
withdraw from the Competition.
This form will be separated from the remainder of the application. Within the remainder of this
patent application, teams must identify themselves only by use of the team number given to them
with the invitation, in December, by the organizing committee.
This form must be accompanied by a complete patent application, a completed IDS and a summary
as stated in the rules: https://drive.google.com/file/d/1a0z_irlDNG3gcaq46Se_7L-RpAKy6y90/view.
LEGAL NAME OF FIRST STUDENT:

(e.g., Given Name (first and middle if any) and Family Name or Surname)
Student's Signature

Date (Optional)

Residence: City

State

Country

School:
Reg. # if granted:

D

Additional students are being named on the supplemental sheet attached hereto.

IPage 2 of 3]

l

[

PTO/AIA/02 (Drafting Competition)
Approved for use through 11/30/2020. OMB 0651-0032
U.S. Patent and Trademark Office; U.S DEPARTMENT OF COMMERCE
Under the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number.

ADDITIONAL STUDENT(S)

Page

of

Legal Name of Second Student:
{e.g., Given Name (first and middle if any} and Family Name or Surname)

Student's
Signature

Date /Oolionan

Residence: Citv

State

Countrv

Schoo!
Reg.# if granted:

Legal Name of Third Student, if any:
(e.g., Given Name (first and middle if any) and Family Name or Surname)

Student's
Signature

Date (Optional)

Residence: City

State

Country

School
Reg.# if granted:

Legal Name of Fourth Student, if any:
(e.g., Given Name (first and middle if any) and Family Name or Surname)

Student's
Signature
Residence: City

Date (Optional)
State

Country

School
Reg.# if granted:
The collection of this information is needed for entry in the National Patent Application Drafting Competition. This collection is estimated to take 10 minutes
to complete, including gathering, preparing, and submitting the completed form to the USPTO. Time wlll vary depending upon the individual case. Any
comments on the amount of time you require to complete this form and/or suggestions for reducing this burden, should be sent to the Chief Administrative
Officer, U.S. Patent and Trademark Office, U.S. Department of Commerce, P.O. Box 1450, Alexandria, VA 22313-1450.

SUBMIT, ALONG WITH THE COMPLETED APPLICATION, TO: [email protected],

If you need assistance in completing the form, email [email protected].

j