APPLICATION FORM - 発明協会



（Form１）

Date_________________

Secretariat of the Future Creation Fair

Japan Institute of Invention and Innovation (JIII)

International Exhibition for Young Inventors

Prior Enrollment Form

On behalf of ________________________________________________(organization name), I,_______________________________, will hereby submit the Prior Enrollment form to take part in the International Exhibition for Young Inventors of August 2004 to be held in Tokyo, Japan.

|Name of Organization | |

|Name of Organization Representative |(As stated in passport) |

|Country and Address of Organization | |

|Person in Charge of Submissions | |

|Name |(As stated in passport) |

|Employment Position | |

|TEL/FAX | |

|Ｅ-Mail | |

|Planned Number of Submissions to the International | |

|Exhibition for Young Inventors |（must be under １０） |

|Please briefly explain the means in which you have chosen| |

|the recommended works you plan to submit. | |

|６．Attendees at Events in Japan |・Please check one. |

| |（ □ will attend □ will not attend ） |

|・If “will attend ” was checked, Please indicate the |Number of Supervisors ______________ |

|number of attendees for each category. |Number of Youth ______________ |

| |Total _____________________ |

|７．General Outline of Your Organization (Main activities, budget scale, etc.) |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

|Note: In the case that your organization sponsors its own invention contests or participates in an invention contest sponsored by |

|another, please outline the main points (targeted participants, participants’ age, theme, etc.) below. |

Note: If the above space is not sufficient, please continue on as many sheets of paper as necessary.

（Form２―１）

Date__________________

Secretariat of the Future Creation Fair

Japan Institute of Invention and Innovation (JIII)

International Exhibition for Young Inventors

Formal Application Form

On behalf of ________________________________________________(organization name), I,______________________________________, will hereby submit the Formal Application form to take part in the International Exhibition for Young Inventors of August 2004 to be held in Tokyo Japan.

|Name of Organization | |

|Name of Organization Representative |(As stated in passport) |

|Country and Address of Organization | |

|Person in Charge of Submissions | |

|Name | |

|Employment Position |(As stated in passport) |

|TEL/FAX | |

|Ｅ-Mail | |

|Total Number of Submissions | |

〈Information Concerning Selected Inventions / Devices〉

|Submission Number |Title of the Invention and/or Device |Name of the Inventor (Please limit to |Date of Birth |Designation for |

| | |one name, even in the case of multiple | |Special Award Yes |

| | |inventors.) | |/ No |

|NO１ | | | |YES / NO |

|NO２ | | | |YES / NO |

|NO３ | | | |YES / NO |

|NO４ | | | |YES / NO |

|NO５ | | | |YES / NO |

|NO６ | | | |YES / NO |

|NO７ | | | |YES / NO |

|NO８ | | | |YES / NO |

|NO９ | | | |YES / NO |

|NO10 | | | |YES / NO |

Note: Please give details for each submission in Exhibition Submission Form 2-2.

〈Information Concerning Attendance at Events in Japan〉

|Number of Attendees (Planned) |Number of Supervisors _______________ |

| |Number of Youth _______________ |

| | |

| |Total ________________ |

|Name of the Representative for the |(As stated in passport) |

|Attendees | |

|Contact Address for the | |

|Representative | |

| | |

|TEL/FAX | |

| | |

|E-Mail | |

Note: Please give detailed information on each attendee in Attendance Form 2-3.

（Form２－２）

Exhibition Submission Form

Please indicate one invention/device per form.

Submission Number

|Name of Organi-| |Country | |

|zation | | | |

|Name of | |

|Submis-sion | |

|Piece | |

| | |

| | |

|Name of |（As stated in passport） |

|Inventor |Family Name: First Name: |

| | |

| |（In case of multiple inventors, please give additional names below.） |

|SEX |Male □ |Age | |Name of School | |Year in School | |

| |Female□ | | | | | | |

| | |Date of Birth | | | | | |

|Collective Inventor(s) |

|(In the case of multiple inventors, please give information on the additional inventors below.) |

|Name of |（As stated in passport） |

|Collective |Family Name: First Name: |

|Inventor | |

|SEX |Male □ |Age | |Name of | |Year in School | |

| |Female□ | | |School | | | |

| | |Date of Birth | | | | | |

|Name of |（As stated in passport） |

|Collective |Family Name: First Name: |

|Inventor | |

|SEX |Male □ |Age | |Name of | |Year in School | |

| |Female□ | | |School | | | |

| | |Date of Birth | | | | | |

|Size of the Submission |

|Please give a detailed explanation of the submission piece. |

|Outstanding characteristics of the invention or device (what sets it apart from previous creations) |

| |

| |

| |

| |

|Effects of the invention or device |

| |

| |

| |

| |

|Other points or aspects that should be considered (ex. Operation method) |

| |

| |

|Necessities for the display（electrical wiring, communication circuits, etc） |

| |

| |

| |

| |

| |

| |

|Please explain your organization’s reasons for selecting the submissions. |

|(ex. History of any awards received, planned entry in a contest within your country, etc.) |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

|Information on patents or other industrial property rights| |

|of this submission (If any). | |

|Please check here if you want exhibition items for this submission returned. | |

| |YES □ NO □ |

|Photograph of the exhibition piece |

|(Please show the internal structure of the work by illustration, if necessary.) |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

| |

（Form２―3）

Attendance Form

Please indicate one attendee per form.

Submission Number

|Name of Organization | |Country | |

|Name of Attendee |（As stated in passport） |

|SEX |Male □ Female□ |Age | |Name of School / year | |

| | | | |in School | |

| | | | |(Supervisor see Note) | |

| | |Date of | | | |

| | |Birth | | | |

|Contact Information | |

|(Home and/ or other) | |

| | |

| |TEL |

| |FAX |

| |E-MAIL |

|Photograph of attendee | |

|(Passport Style Photo | |

|3×3cm） | |

| | |

| | |

| | |

Note: If you are a member of invention related organization, please indicate organization name and position. If you are a guardian, please indicate your relationship to the youth.

-----------------------

Place Photo here

Place Photo here

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download