Application Form

Click this link to Download in PDF format

or fill out and print out the form below

Please print out this form and fax or mail it in:

Please call us at 775 244-7174 [please leave a short voice mail with your name and phone number] if you have any questions.

Reservation Confirmation Number:
____________________________

Date: _________________

Name: __________________________________ Title: ____________

Company Name: ___________________________________________

Address: _________________________________________________

City: _____________________________ State: _______Zip: _______

Telephone: (home) (___) ___________ (business) (___) ____________

Invention / Product to be exhibited:
____________________________________________________________

I am applying for participation in the following program(s). Reservations and discount offers are held for a maximum of 5 days and are confirmed only upon receipt of payment. Price protection for discount offers is guaranteed only with payment in full. I understand that all services, products, promotions, discounts, and retail prices are subject to change or cancellation without notice unless secured by a deposit payment. I understand that all agreements and rules governing services are applicable. Signature warrants that applicant comprehends the program(s) being purchased, and has read and understands any and all rules and regulations. I have read and understand this agreement.

Signature: _________________________________________ Date: ______________

PAYMENT REMITTANCE:

Total Amount Due: $ _______________ Amount Enclosed: $ ________________

1) ____PAYPAL __paid online
2) ____Send me a Paypal invoice
3) ____U.S. Post Office "Money Order" enclosed [note: only Post Office money orders are accepted; personal/company check, alternate money orders or cashier's checks are not accepted for payment]
4) ____Credit card payment

1. Issue U.S. Post Office "Money Order" made payable to: Stephen Gnass
2. In the memo write: Cyber-Exhibiting program
3. Mail by U.S. Post Office "Priority Mail" with "Delivery Confirmation" to: InventionConnection.com Order & Processing, 8306 Wilshire Blvd., Ste 391 Beverly Hills, CA 90211

Credit Card Type: __Visa __MasterCard __Discover __AMX
Name on card:________________________________________________________
Card number: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
Expiration date: _________
3-digit security code on back: ____ ____ ____
Billing address:________________________________________________________

And...please be sure to print out, sign and include the Rules Governing the Invention Connection®.