Volunteer: Patent Pro Bono

Volunteer Patent Pro Bono Application
Salutation
First Name*
Middle Name
Last Name*
Pronouns*
Gender*
Race*
Birthdate

MonthDayYear
Date
Email*
example@example.com
Phone*
Please enter a valid phone number.
Home Address*

Street Address

Street Address Line 2

CityState

Zip Code
Law Firm / Organization Name*
Title (Partner, Associate, Of Counsel, Patent Agent etc.)*
Law firm/organization address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Where are you barred?

MarylandWashington D.C.VirginiaOther StateFederal Court (District)
Are you currently a law student?

yesno
Law School
Law School Graduation Year
I am registered to practice with the USPTO*

YesNo
Lawyer or Patent Agency Registration Number*
I have handled at least (3) patent applications*

YesNo
When did you pass the Patent Registration Exam?
Do you have malpractice Insurance*

YesNo
Carrier Name
Malpractice Insurance Policy #
Practice areas that I am willing to work on (select all that apply)

DesignSoftwareMechanicalChemicalBio/Life SciencesOther
Billable Hourly Rate*
How did you hear about us?*
Please share how you heard of MDVLA.
Share the language(s) other than English that you would be comfortable conversing in with a client.

SpanishChinese Incl. Mandarin CantoneseFrench Incl. CajunOther
Please provide any additional information you would like us to know about you.
Lead Source
Lead Status

Open - Not Contacted
Lead Record Type

Volunteer Lead
OwnerId
Should be Empty:

Volunteer Patent Pro Bono Application