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CONFIDENTIAL Reference No. (this space for UILO use
 

Summary: CONFIDENTIAL
Page 1of 6
Reference No. (this space for UILO use
only): ____________________
Disclosure of Intellectual Property
Please complete each section of this form and attach additional material as appropriate.
1. Title of Intellectual Property:
2. Inventor(s)/Creator(s) Information: (Attach additional forms if more than two inventors/creators.)
Name: Citizenship:
Faculty/Department: Position/Title:
Social Insurance Number: Fax:
Office Phone: Home Phone: Cellular:
Email: Website:
Office Address: Home Address:
City: Province: City: Province:
Postal Code: Postal Code:
Name: Citizenship:
Faculty/Department: Position/Title:
Social Insurance Number: Fax:
Office Phone: Home Phone: Cellular:

  

Source: Argerami, Martin - Department of Mathematics and Statistics, University of Regina

 

Collections: Mathematics