Please complete this form if you are interested in becoming a volunteer attorney with the Ohio Invents & Patent Pro Bono Program for Ohio. (* = Required Field) First Name* Last Name* Street City State/Province --None-- OH MI Zip Country US Email* Law Firm/Company* Office Phone* What languages do you speak fluently? Are you a CIPLA member? --None--Yes No WHAT TYPE OF LAW DO YOU PRIMARILY PRACTICE?Patent Law Trademark Law Business & Corporate Services Law WHAT TYPE OF SPECIFIC SERVICES ARE YOU INTERESTED IN PROVIDING (e.g., patent applications, licencing agreemeents, charter documents)?: USPTO # (patent attorneys & agents) Where are you licensed to practice? --None-- Kentucky Ohio State bar number State bar admission date What kind of technology do you work with (patent attorneys & agents)? What application type would you prefer to receive (patent attorneys & agents)? [Hold down “Ctrl” to select more than one option.] Consumer Products Electronics Life Sciences Mechanical Other When will you be available to start reviewing pro bono referrals?