Medical and Health Care

STARTUP COMPETITION

A source of innovation

Deadline // October 1, 2022

Submit a project

Entry application

to JERELO EXPO
I request access to our company (me) to be part of JERELO EXPO

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

1000

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