For valuable consideration, I do hereby authorize The University of Texas , and those acting pursuant to its authority to:
Name: _______________________________________________
Address:______________________________________________
Phone No.:____________________________________________
Signature:_____________________________________________
Witness Signature:______________________________________
Parent/Guardian Signature (if under 18):_____________________
Agreements, Forms and Samples | Intellectual Property Section
University of Texas System Office of
General Counsel
Comments to intellectualproperty@utsystem.edu
Last updated: November 28, 2001
