Nome*:

Cognome*:

Funzione*:

Nome Azienda/Istituzione*:

Settore*:

Città*:

Sito Web:

Email*:

*Campi obbligatori

CONTACT

Name of company*:

Contact person*:

Email Address*:

Address*

Telephone

Postcode*

City*

Website*

Country*

Description of activity:

EXPERTISE OFFERED

Description of activity*:

Keywords specifying the expertise*:

EXPERTISE REQUIRED

Description of activity*:

Keywords specifying the expertise*:

EXPECTATIONS

Term commitment*:
Short(<1 year)Medium(1 to 3 years)Long(more than 3 years)

Purpose*:
aquire new technology / productdevelop new technology / productdemonstrate the viability of a new technology / productupgrade new technology / productother

If you have chosen "Other":

Target partner (expertise)*:

Country*:

Expected results for your organisation*:

CONSENT

I confirm that I am entitled to release the information provided in the Expression of Interest. I understand that information submitted in this form will be provided only to the Project Co-ordinator in the context of the Partner Search to which I am replying.

Name*:

Company*:

Title*:

Date (dd/mm/yyyy)*:

*Required fields