Member Information Questionnaire

Please Check One: (you MUST check one to submit survey)

I give permission to list the following information for inclusion in the Member Profile Pages of the IANE website, accessible to members only. I may or add or delete information at any time through the 
Profilemaster.

I do not wish to be listed on the Member Profile Pages at this time.

Name: 

Street Address:

City, State, Zip: 

Phone Number(s):

Email:

URL:

Willing to be contacted by other members?
Yes
No

Preferred means of contact:
Email
Phone, contact hours:

In what areas have you already invented/are no longer interested in and are willing to talk about? Any areas you have dabbled in/worked on in the past and have expertise and are willing to share information? Please do not disclose any any unprotected information/material.

What are you working on that you would like help from other members?
Do you want this information to be listed in the "Help Needed" Page of
the Member’s Website?

Patents?

Are you willing to collaborate with other members? (Choose one) 
Yes
No

Do you run a business useful to inventors?  Please Explain.

Do you want us to link to any of your business materials or website(s)? Please provide links and info.

Are you available to offer limited free coaching to other members?  What are your specialty areas?

Other Background or Comments: