Registration Form

OMB Control No.: 0651-0080

Expiration Date: XX/XX/XXXX

One-Day Patent and Trademark Boot Camp Intensive Registration Survey

First name

Last name

Address 1

Address 2

City

State/province

ZIP/postal code

Country/region

Email address

Company

Title

Phone number

Course ☐ Patent Boot Camp ☐ Trademark Boot Camp

1. Have you already filed a patent application? ☐Yes ☐No

2. Have you already filed a trademark application? ☐Yes ☐No

3. Do you plan on filing a patent application? ☐Yes ☐No

4. Do you plan on filing a Trademark application? ☐Yes ☐No

5. Please provide your USPTO customer number (if you have one)? Click or tap here to enter text.

6. Are you registered to practice law in patent matters before the USPTO? ☐Yes ☐No

7. Do you want to be notified of future courses? ☐Yes ☐No

8. How far are you travelling to attend the Boot Camp? ☐Yes ☐No

9. Do you have reliable access to the internet? ☐Yes ☐No

By participating in this course, you authorize us to contact you for follow- up questions.

A Federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with an information collection subject to the requirements of the Paperwork Reduction Act of 1995, unless the information collection has a valid OMB Control Number. The OMB Control Number for this information collection is 0651-0080. Public burden for this registration survey is estimated to average 3 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the information collection. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden to the Office of the Chief Administrative Officer, United States Patent and Trademark Office, P.O. Box 1450, Alexandria, VA 22313-1450 or email [email protected].