IBC building . M-38/1 . Middle Circle . Connaught Place . New Delhi 110 001 . INDIA . Tel. +91 11 4517 2200 . Fax. +91 11 4517 2209 .

Web. www.ebtc.eu . E-mail.

EBTC Biotech Flagship Mission

Bangalore, India – 31st May – 4th June 2010

Please fill out your details below to register your interest in taking part to the EBTC Biotech Flagship Mission and matchmaking event in Bangalore. A member of our team will contact you once your profile has been verified.

Please return the form filled in to:

Marina Calcagno – email fax +39 02 8515 5308

COMPANY PROFILE
COMPANY
ORGANISATION NAME
ADDRESS
POSTAL CODE
CITY
PHONE
E-MAIL
WEB
CONTACT PERSON
POSITION
MOBILE
LANGUAGES SPOKEN
ORGANISATION TYPE
q  Large company
q  SME
q  Spin off
q  Start up / q  University/Academic/TTO / q  Government
q  Industry association / q  Research Centre / q  Science / business park
q  Bio Bank / q  NGO / q  Other (please specify)
OTHER INFORMATION
YEAR OF ESTABLISHMENT
N. OF EMPLOYEES / R&D PERSONNEL
TURNOVER - R&D (%)
EXPORT (%)
STRENGHTS
INNOVATIVE PRODUCS/PROCESSES:
PATENTS/LICENSES/TRADE MARKS:
R&D:
EXPERTISE:
INTERNATIONAL EXPERIENCE:
ACTIVITY
q  R&D / q  Manufacturing / q  Services (R&D, business) / q  Other
DESCRIPTION:
FIELD OF ACTIVITY
Food Biotech (Agriculture) / Industrial Biotech
q  Functional foods / q  Molecular genetics
q  Plant genoma / q  Bioremediation
q  GMO / q  New refrigerating eco-compatible fluids
q  Fodder and bran / q  Waste management
q  Transgenic Crops / q  Microbial processes
q  Livestock and poultry / q  Biorefineries
q  Aquaculture / q  Biomass Conversion
q  Feed additives / q  Biodiversity
q  Aquaculture / q  Renewable resources
q  Feed additives / q  Advanced energy technologies
q  Bioreactors / q  Bioinformatics
q  Process Engineering / q  Biopesticides
q  Nutraceuticals / q  Energy saving
q  Fermentation / q  Transgenic production
q  Process development / q  Soil washing
q  Other (please state): / q  Recycling
q  Packaging
q  Process development
q  Other (please state):
MATCHMAKING FORM
PARTNERSHIP OBJECTIVES
q  Commercial intermediary (distributor, general agent, etc.)
q  Activation of new projects (R&D)
q  General commercial assistance
q  Technology transfer or production licensing
q  Identification of new customers
q  Mutual/common distribution agreement
q  Direct investments
q  Joint creation of an enterprise or consortium
q  Financial participation
q  Development of new products
q  Venture capital
q  Other
PLEASE DESCRIBE YOUR BUSINESS PROPOSAL / PROJECT IDEA
HOW DOES THIS FIT IN YOUR INTERNATIONAL STRATEGY?
HOW DO YOU SEE THE PARTNERSHIP YOU WISH TO DEVELOP IN 3 YEARS?
TYPE OF PARTNER REQUIRED
I understand that my details will be forwarded to the European Union and held by EBTC.
Name
Position
Date
Authorised signature