AMERICAN INTELLECTUAL PROPERTY LAW ASSOCIATION
241 18TH STREET SOUTH, SUITE 700, ARLINGTON, VIRGINIA 22202
TELEPHONE (703) 415-0780
FAX (703) 415-0786

APPLICATION FOR MEMBERSHIP

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PLEASE TYPE OR PRINT THIS FORM

1. Name (Mr./Ms.)____________________________________________________________________

2. Home Address ___________________________________________________________________
   (city, state & zip)

3. Office Address ___________________________________________________________________
   (city, state & zip)
******please check the box above for which address you prefer as your primary mailing address******

4. Office Telephone Number____________________________________________________________

Office Fax Number____________________________________________________________________

E-Mail Address_______________________________________________________________________

5. Name of Firm, Corporation, Teaching or Government Institution

___________________________________________________________________________________________

6. REGULAR, JUNIOR, GOVERNMENT AND ACADEMIC MEMBERSHIP
Bar Membership(s) (state(s) and month(s)/ year(s) of admission)

___________________________________________________________________________________________
(Must be completed)

7. PATENT AGENT, PATENT AGENT JUNIOR MEMBERSHIP
Patent Bar Number and Patent Bar Date (month (xx)/day (xx)/year (xxxx))

___________________________________________________________________________________________
(Must be completed)

8. Have you ever been reprimanded by or refused admission to practice, disbarred or suspended from practice before any court or administrative agency?

___________________________________________________________________________________________

9. If the answer to question 8 is in the affirmative in any respect, give complete details on separate sheets affixed to this application.

10. FOREIGN AFFILIATE MEMBERSHIP
Name of Law School where legal education and degrees were obtained

___________________________________________________________________________________________

Courts or tribunals admitted to practice as an attorney

___________________________________________________________________________________________

Citizen of___________________________________________________________________________

11. LAW STUDENT/GRADUATE AFFILIATE
Name of Law School/Graduation Date (Month and Year)

_____________________________________________________________________________________________
(Must Be Completed)

MEMBERSHIP APPLIED FOR AND REQUIREMENTS FOR ADMISSION
——Payment of Dues MUST Accompany the Application——

__________Regular (Dues $285.00) — persons whose practice in the opinion of the Board of Directors of the corporation conforms to the Code of Professional Responsibility of the corporation, and who, unless admitted to membership prior to August 1, 1937, shall be, and have been for a period of five years or more, members in good standing, of the Bar of a court of record of the United States or any State or Territory thereof or of the District of Columbia. Regular members shall have the right to vote and hold office.

__________Junior (Dues $120.00) — persons qualified for regular membership except that they shall be, and have been members in good standing, of the Bar, as referred to above, for a period of less than five years from the date of their first admission.  Junior members shall not be eligible to hold office. When junior members shall have completed five years membership of the Bar, in good standing, they shall be transferred automatically to regular membership.

__________Academic (No Dues Required) — persons qualified for regular or junior membership but who are full time professors in a law school approved by the Association of American Law Schools. Academic members are entitled to the privileges of the membership for which they are qualified.

__________Government (Dues $80.00) —Persons qualified for regular or junior membership who are full-time employees of a government. Government members are entitled to the privileges of the membership for which they are otherwise qualified.

__________Foreign Affiliate (Dues $310.00) —persons who are not citizens of the United States but are regularly recognized as members of the legal profession by the country of their citizenship. A foreign affiliate shall not be entitled to vote or to hold office.

__________Law Student/Graduate Affiliate (Dues $45.00) —The law student/graduate affiliate membership shall consist of persons who may not be qualified for regular or junior membership but who are regularly enrolled as candidates for a professional law degree from a law school approved by the Association of American Law Schools, or who have graduated and received a professional law degree within the past year from a law school approved by the Association of American Law Schools, and who would be otherwise qualified for junior or regular membership if a member of the Bar. A person remains eligible for a law student/graduate affiliate membership for up to one year from his/her date of graduation from law school. If the law student/graduate affiliate becomes a member of the Bar within that one-year period, he/she may request transfer to junior membership. Law student/graduate affiliates shall not be entitled to vote or to hold office.

__________U.S. Patent Agent Affiliate Membership (Dues $285) —persons who are registered to practice before the United States Patent and Trademark Office for a period of five years or more, and who are not otherwise qualified for regular or junior membership, whose practice in the opinion of the Board of Directors of the Corporation conforms to the Code of Professional Responsibility of the Corporation, and who shall be, and who are and remain members of good standing on the Registry of Patent Agents maintained by the United States Patent and Trademark Office. If the U.S. Patent Agent becomes a member of the Bar qualified for Regular Membership at a later date, he/she may request transfer to Junior Membership. U.S. Patent Agent Affiliates shall not be entitled to vote or to hold office.

__________U.S. Patent Agent Junior Affiliate Membership (Dues $120) —Persons qualified for Patent Agent Affiliate Membership except that they shall be, persons who are registered to practice before the United States Patent and Trademark Office for a period of less than five years. If the U.S. Patent Agent becomes a member of the Bar qualified for Regular Membership at a later date, he/she may request transfer to Junior Membership. U.S. Patent Agent Affiliates shall not be entitled to vote or to hold office.

CERTIFICATE

By signing below, I hereby state that everything on this form is true and correct and I qualify for the class of membership or enrollment that I am seeking and I agree to abide by the Code of Professional Responsibility, the Articles of Incorporation and the By-Laws of the Association.

*No other cards accepted.

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Applicant, type or print name clearly