Fillable Independent Inventor Idf Fillable 6-1-2015 (University of Wyoming)

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Independent Inventor Idf Fillable 6-1-2015 (University of Wyoming)

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Rev. 05/22/15 Page 1 of 3
RPC NO. __________ RPC Use Only ACCT. NAME ________________
WYOMING RESEARCH PRODUCTS CENTER
INVENTION DISCLOSURE FORM*
*Note: For Use by Independent Wyoming Inventors
1. TITLE OF INVENTION
2. DESCRIPTION OF INVENTION: In describing the technology, please provide information covering the
following points:
Please Use Text Boxes for Describing Technology and/or Attach Additional Pages
General purpose:
Technical description:
Rev. 05/22/15 Page 2 of 3
3. INVENTOR(S)
(If more than 3 inventors, please download Additional Inventors Form)
FIRST INVENTOR
Name:
Phone:
F
ax:
E
mail:
Address:
S
tate: Cit
y
: Zi
p
:
SECOND INVENTOR
Name:
Phone:
F
ax:
E
mail:
Address:
S
tate: Cit
y
:
THIRD INVENTOR
E
mail:
Address:
S
tate: Cit
y
:
F
ax:
Zi
p
:
Name:
Phone:
Zi
p
:
Advantages & improvements over existing methods, devices, or materials:
Marketing opportunities or commercial applications:
Rev. 05/22/15 Page 3 of 3
Inventor’s Name:
Inventor’s Name:
Inventor’s Name:
S
ubmit To: W
y
omin
g
Research Products Center, De
p
t. 3672, 1000 E. Universit
y
Ave., Laramie, WY 82071
4. REDUCTION TO PRACTICE OR PROTOTYPE
Has the invention been reduced to practice or has an actual prototype been made? YES NO
5. BY SIGNING OR SUBMITTING THIS TECHNOLOGY DISCLOSURE, YOU INDICATE THAT YOU
ARE USING THIS SERVICE AT YOUR OWN RISK. THE UNIVERSITY OF WYOMING, ITS
EMPLOYEES, TRUSTEES, OFFICERS, STUDENTS, INTERNS AND CONSULTANTS EXTEND NO
WARRANTIES AND ACCEPT NO LIABILITY BY PROVIDING INTELLECTUAL PROPERTY
SERVICES TO INVENTORS. THE UNIVERSITY PRESERVES ITS CONTRACTUAL SOVEREIGN
IMMUNITY.
6. SIGNATURES
ate:
S
i
g
nature:
ate:
S
i
g
nature:
ate:
S
i
g
nature:
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Independent Inventor Idf Fillable 6-1-2015 (University of Wyoming)

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Completed 21 July 2020

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