Name of Organization

Address

Website

Type of Organization

□Enterprise
□Consultancy company
□Investment company
□Academic institution
□MBA student
□Embassy 
□Chamber of Commerce
□Others

Have you ever participated in a New Ventures event?
□Yes       □No

How did you learn about program and activities?
□New Ventures homepage □WRI website □Newsletter
□Others

Participant information (If there are several participants from your institution, please fill out separate forms.)

Name

Position

Telephone

Fax

E-mail

Mobile phone