INSTRUCTIONS
 Provide all personal information and contact information of applicant (page 1)
 Provide all written description (page 2) & visual sources (page 3) of the invention
 Use more spaces if needed; forms can be extended for extra pages if necessary (page 3)
 Submit the completed application entry form by EMAIL  [email protected]
SECTION I : APPLICANT INFORMATION
Full Name of Inventor(s)
(no more than 5 names)
City / Country of Origin
School or Organization
Full Mailing Address
(in capital letters)
Contact Person
(for communication including
Contestant/Finalist Updates and
for other necessary details)
Ex.) team representative
Name
Organization
Email Address
Phone No.
SECTION II : INVENTION ENTRY INFORMATION
Title of Invention
Entry Category
Choose from Application Categories A~V (Listed on Brochure)
Abstract of Invention
(inclusion in event catalogue)
(Max. 100 words)
(Font: Cambria, 10pt)
Award Winning History
(highest awards only; if any)
Intellectual Property Status
(current IP rights of invention)
1
Patented
[
]
Patent Pending
[
]
Not Patented
[
]
Utility Model
[
]
PRELIMINARY ROUND ENTRY PRESENTATION FORM
This form will be used to determine Preliminary Round Qualification & Winners (Finalists)
SECTION I : WRITTEN DESCRIPTION OF INVENTION ENTRY


Description must be written in English for proper evaluation (max. 6 lines for each part)
Use the relevant questions on the left column to guide your statement on the right column
PROBLEM STATEMENT?
MOTIVE BEHIND ITS IDEA?
RESEARCH METHOD?
INNOVATIVE FEATURES?
TECHNICAL EFFECTS?
DEGREE OF COMPLETION?
CONTRIBUTION TO SOCIETY?
ENVIRONMENT-FRIENDLY?
ECONOMIC ADVANTAGE?
CURRENTLY MARKETED?
POTENTIAL USERS/BUYERS?
FUTURE PROSPECTS?
SECTION II : APPLICANT GUARANTEE & CONSENT
INTARG 2017 Final Round
& Award Ceremony
(if selected as Finalist)
Will Attend
[
]
Will Not Attend
[
]
I, ________________________ (Applicant) desire to participate in 2017 International Exhibition of Invention
Innovation in Poland (INTARG 2017) and agree to abide by the competition rules & regulations, and the terms
of reference set by the Organizer with the full guarantee that all information provided on this form is correct
and does not infringe on the intellectual property rights of others. I will be responsible for any violation of
intellectual property rights if happens, and the Organizer assumes no liability for such infringement.
Applicant Signature: ___________________________________
Date: ___________________________________
2
SECTION III : VISUAL SOURCES OF INVENTION ENTRY
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
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Provide any visual sources and documents of the invention (min. 1 visual source required)
Attach image files of photos, charts, diagrams, etc directly on the space provided below
You can also provide text + visual reports if necessary
* Extend extra pages if necessary
3