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CONFIDENTIAL Reference No. (this space for UILO use

Page 1of 5
Reference No. (this space for UILO use
only): ____________________
Request for Statement of No Significant Use of
University of Regina Facilities or funds or
Waiver of University of Regina Ownership Rights
Please complete each section of this form and attach additional material as appropriate. Text boxes will expand to
accommodate content.
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:


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


Collections: Mathematics