PorPeoples' Invention Registry Form

Address:                                                                                                 Apartment #:              

City:                                                                         State:                 Zip Code:                

Email Address:                                                

Home Phone:   (       )         -           Mobile Phone: (       )         -          

Work Phone:   (       )         -        

1. [   ] I am over 18 years of age.
2. [   ] I am under 18 years of age.
   • [   ] Check if you are elementary to middle school age.
   • [   ] Check here if you are high school age (high school seniors over the age of 18 may check here as well).

How were you referred to PPIR (please check all that apply)?:

1. [     ] Television Advertisement
2. [     ] Radio Advertisement
3. [     ] Newspaper
4. [     ] Webpage or Search Engine
   • Please list URL here:                                                
5. [     ] Friend, co-worker, family member (circle one)
6. [     ] Another inventor
   • Note: If you were referred by another inventor, please follow instruction No. 5 from the registration instruction page here:                                                                                                

Please Describe Your Invention/Idea:                                                                                        

I certify that the information contained in this registration form is accurate to the best of my knowledge and understand that any misrepresentation on my part may lead to cancellation of my registration without refund. I understand that PorPeoples' Invention Registry will not submit my registration without my expressed permission to any third party and I agree to abide by all rules of registration as of my date of valid registry.

Signiture:                                                                                   Date:                                

PorPeoples' Invention Registry is a limited liability corporation (LLC). We will not sell your ideas to a third party registry or other companies interested in your inventions. We will store your ideas for one full year from your date of registry, and you may reregister at any time after your registry expires on an annual basis. We are here as a registry service and storage facility for invention ideas only. It is the sole responsibility of the inventor to pursue their own invention goals.