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PLEASE ENTER YOUR CONTACT INFORMATION AND THE TECHNOLOGY INFORMATION REQUEST BELOW:

Your Contact Information (section must be completed before information can be sent):

First Name: Last Name:
Title:
Department: Company:
Phone: Fax:
E-mail:
Address:
City: State: Zip Code:
Country:

Major company interests: Please let us know what your company technology needs are, so we can keep you aware of new technologies as they are developed at UT Southwestern.

Please enter UTSD or US Patent number(s) for the technologies in which you are interested. UTSD numbers may be obtained from the Hot List or through Search for Technology Available for Licensing. The US Patent numbers may be obtained from the Issued Patents page:

Note: Confidential information for technologies with no patent listed requires execution of a Confidential Disclosure Agreement.

You may clear your entries by clicking on "Clear Entries" or submit your request by clicking the "Submit Request" button.