Medical and Health Care
STARTUP COMPETITION
A source of innovation
Deadline // October 1, 2022
Title
Enter the name of a legal entity or the name of an individual applicant
Registration date / Birthdate
Enter the registration date of the legal entity or the birthdate of the individual applicant
State registration number / Identification number
Indicate the state registration number of the legal entity or the taxpayer identification number of the individual applicant
Registered address
Enter the address where the legal entity or the individual applicant is registered
Location address
Enter the current location address of the legal entity or a residence of the individual applicant
Name of the head of the legal entity
Full name of the head of the legal entity
Name of the authorized representative
Enter the name of the person who is duly authorized to represent interests of the legal entity at JERELO EXPO
Contact phone
E-mail
Website, and Social Network
Specify the company's website, Facebook / Instagram / LinkedIn
Activity / Competences
Describe the legal entity activity or an activity and competences of the individual applicant
I am familiar with JERELO EXPO Statute and membership conditions, I share them and undertake to fulfill them. I confirm that all information which is provided in this declaration and all future information to JERELO EXPO is true. By signing of this declaration I consent the collection, storage, processing and use of personal data in accordance with the Law of Ukraine "On Protection of Personal Data" to fulfill the goals and objectives provided by the Statute of JERELO EXPO
Date of application
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