SEG Enrollment

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If you are interested in having your company added to Patent and Trademark Office FCU's Field of Membership, please complete the following information and return it to the address below.

Date:

/ /

Full Name:

Title:

Company Name:

Address:

Suite / Apt.:

City:

State:

Zip:

Email Address:

Telephone Number:

Number of Employees:

Distance from PTOFCU:

FOM Wording (all employees, employees in particular office, employees and volunteers, etc.):

I certify that the above information is correct to the best of my knowledge and that I have signing authority for this company or organization.

Security Code:

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SEG Enrollment