Maurice Klitzman Award Application 2020 Question Title * 1. Name OK Question Title * 2. AIPLA Member Number OK Question Title * 3. Email Address OK Question Title * 4. Phone Number OK Question Title * 5. Name of Employer OK Question Title * 6. Position/Title OK Question Title * 7. Years at the Company OK Question Title * 8. Does your employer support involvement in AIPLA? Yes No OK Question Title * 9. Would your employer support continued involvement Yes No OK Question Title * 10. Are you an attorney? Yes No OK Question Title * 11. Are you a patent agent? Yes No OK Question Title * 12. # of years as an IP Practitioner OK Question Title * 13. # of years in a corporate environment OK Question Title * 14. # of years as an AIPLA member OK Question Title * 15. Why did you join AIPLA? Career Development CLE/Education Networking Other (please specify) OK Question Title * 16. To what AIPLA Committees, if any, do you belong? Please list: OK Question Title * 17. Have you ever attended an AIPLA Meeting? Yes No OK Question Title * 18. If yes, which meetings have you attended? OK Question Title * 19. What do you hope to achieve/learn through attendance at the Annual Meeting? OK Question Title * 20. If you are selected for the Klitzman Award, you will be assigned a mentor. The mentor will provide guidance on program and event selection at the meeting and introduce you to members of the AIPLA leadership. Your mentor will assist in sustaining your future involvement in AIPLA. Please indicate your are of interest so we can identify a compatible mentor. Antitrust Copyright Patent Trade Secret Trademark Litigation Prosecution Biotechnology Chemical Electronic Internet Technology Medical Technology International OK Question Title * 21. Nomination/Sponsorship recommendation. 1. Please provide a recommendation from your employer, supervisor, or a co-worker if you have no appropriate immediate supervisor. 2. Please provide a recommendation from an AIPLA member. Recommendations can be send directly to mdonohoe@aipla.org. OK DONE