217 Ninth Street, Pittsburgh, Pa 15222
Phone: 1-888-54-INPEX
Fax: 1-412-288-4546
www.INPEX.com
IMPORTANT!
As an exhibitor, you are entitled to receive a complimentary listing in the INPEX 2016 Official Show Program
that consists of your name (or company name), your contact information, you invention name, a 25 word
description and booth location. Please complete the following information, filling in those items that are
applicable. Deadline for this form is April 7, 2016
1.) DELEGATE CONTACT INFORMATION
Name of Delegate:
EUROBUSINESS-HALLER
Delegate Address:
Obroki str. 133
City:
Postal Code
Country:
Katowice
40833
POLAND
Delegate Telephone with Country Code:
0048 32 355 38 01
Fax:
0048 32 355 38 00
Delegate Email Address:
Website:
[email protected]
www.haller.pl
2.) INVENTION INFORMATION & INTERNATIONAL AWARDS PROGRAM JUDGING
INFORMATION - PLEASE COMPLETE THIS FORM IN ENGLISH ONLY!
Besure tolisttheinventionname and25word descriptionfor EACHinventionyou aredisplaying. This information is
what will appear in the INPEX 2016 Official Show Program. We will include the contact information listed in this
section, along with the 25-word description that you provide of the invention in the Official INPEX Show Program.
Please list the information exactly the way you would like it to appear. If the invention name or company name are
trademarked or registered, please note that by typing (tm) or (r). If there is any information you do not want included
in your listing, please note (do not publish) in the corresponding field below.
INPEXJudgingProcess:
Inventions are judged by one or two jury members qualified in a particular catergory(ies). Each invention is rated on
a points system and judged based on the following criteria:
1.) Usefulness 2.) Creativity 3.) Overall Appeal
Awards include INPEX gold medals in more than forty categories. There are also corporate sponsored trophies and
Grand Prix cash prizes of $7,500, $3,000 & $2,000. All winners will be announced at the INPEX 2016 International
Awards Ceremony.
If your invention fits into more than one category, you may wish to have it judged in multiple categories. Your first
judging category is free. Additional categories are $75 each and include corresponding category listing in the INPEX
2016 Official Show Program.
Your Awards Certificate(s) will be issued with the information you provide below. Be sure all spelling, capitalization,
punctuation and spacing is EXACTLY as you wish it to appear on the award certificate. (include ® or ™ if applicable
by noting (r) or (tm).) There will be a $5.00 charge per certificate if you request changes after the certificates are
issued. Duplicate certificates and medals will also be available at $5.00 per certificate and $25.00 per medal.
FORMS MUST BE RETURNED BY MAY 1, 2016 (Failure to return the form by deadline date may result in
being excluded from the INPEX 2016 Official Show Program and/or Judging.)
1. Name of Inventor or Company
………………………………………………………………………………………………………………………………………………………………..
Inventor Address:
………………………………………………………………………………………………………………………………………………………………..
City:
Postal Code
Country:
………………………………….
………………………….……….
……………………….…………………………….
Inventor Telephone with Country Code:
……………………………………………………….
Fax:
………………………………..………………………………….
Inventor Email Address:
Inventor Website:
…………………………….……………….
………………………………………………………………….…….
Invention Name:
………………………………………………………………………………………………………………………………………………………………..
25 Word Description of Invention
………………………………………………………………………………………………………………………………………………………………..
………………………………………………………………………………………………………………………………………………………………..
………………………………………………………………………………………………………………………………………………………………..
………………………………………………………………………………………………………………………………………………………………..
Has a patent been filed for this invention?
If Yes, what kind or where?
……………………………..……………………….
Yes
No
Name (company or individual(s)) that you wish to appear on an awards certificate (if an award is won):
………………………………………………………………………………………………………………………………………………………………..
………………………………………………………………………………………………………………………………………………………………..
Invention Name to be judged exactly as you wish it to appear on an award certificate (if an award is won):
………………………………………………………………………………………………………………………………………………………………..
………………………………………………………………………………………………………………………………………………………………..
I wish to have the above referenced invention judged in the following
categories:
(Please choose your categories. First category is FREE, $75 each after)
CATEGORIES:
Advertising
Alternative Energy
Animal Care
Arts/Crafts
Bath/Accessories
Biology Related Products
Computer
Design (Technical)
Electrical/Electronics
Entertainment
Food/Beverage
Gadgets
Hardware/Tools
Household
Infant/Child Care
Lawn/Garden
Novelties/Household
Office Supplies & Stationary
Personal Care Products
Safety & Security/Industrial
Science
Sports
Toys & Games
TOTAL:
………….. USD
Agriculture
Alternative Medicine/Therapeutic
Apparel/Accessories
Automotive/Transportation
Bath/Plumbing
Cleaning Products & Equipment
Construction
Education
Engineering
Environmental
Furniture
General Goods & Sundries
Health/Fitness
Industrial Equipment
Kitchen
Medical
Novelties/Specialty Gifts
Outdoor
Recreation
Safety & Security/Personal
Specialized Technology
Telecommunications
Wellness / Fitness
Do you have another invention:
Yes
No
3.) PUBLICITY RELEASE FORM
I hereby grant permission for InventHelp’s INPEX to use my delegation's name and/or likeness in any publicity,
marketing, promotional or media materials. I agree that any reproduction of my delegation's appearance at
InventHelp’s INPEX may be edited, adapted, expanded, revised or modified at INPEX’s discretion.*
Agree
Need Clarification
Delegate Name: EUROBUSINESS-HALLER
Date: 11.04.2016
4.) BOOTH SIGN ORDER FORM
PROSZĘ WYPEŁNIĆ W PRZYPADKU ZGŁOSZENIA MIN 3 WYNALAZKÓW
Each booth purchased is entitled to one complimentary Booth Identification Sign. The signs are 7” high x 44” wide.
They are white with black type, centered, in block letters. You can choose to have the inventor's name, the invention
name, or the company name printed on this sign. Logos & graphics cannot be printed on this sign. The more
printing one has on a sign, the smaller the type will appear. Please list ALL signs for your delegation as you wish
them to appear on the line(s) below.
Be sure spelling, punctuation, capitalization and spacing is EXACTLY as you wish it to appear. Type in
ENGLISH only! INPEX must have this form before May2,2016 so that your signs will be ready for the
exhibition.
NOTE: There will be a charge of $15 per sign for changes or additional signs requested onsite at INPEX..
1. Booth Sign
………………………………………………………………………………………………………………………………………………………………
2. Booth Sign
………………………………………………………………………………………………………………………………………………………………
5.) BADGE & AWARDS CEREMONY FORM
Under Badge Name, please write a complete list of everyone who will be participating with you at INPEX 2016.
Please include yourself and all other members of your delegation (including partner(s), spouse, children, etc.).
All participants need a badge to enter the show floor.
You can receive up to 2 complimentary admission tickets to the INPEX 2016 Awards Reception and Ceremony.
Please note below which of your guests will/will not be attending the ceremony so that we can maintain a proper
count. Tickets must be requested in advance and will be included in your exhibitor kit upon arrival .
1.) Given Name - Family Name:
…………………………………
2.) Given Name - Family Name:
…………………………………
3.) Given Name - Family Name:
…………………………………
Attending the
Awards Reception
& Ceremony?
Yes
No
Complimentary
Yes
No
Additional: $25
Yes
No
Additional: $25
Total Due:
Awards Reception & Ceremony Schedule:
5:00pm – 6:00pm Cocktails & Hors D‘Oeuvres
6:00pm – 7:30pm Awards Ceremony
6.) ADDITIONAL CHARGES & PAYMENT WORKSHEET
Total from Section 2
(Additional Judging Categories):
Total Additional Charges:
Total from Section 5
(Additional Awards Reception Tickets):