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Informations

Name of commercial liaison unit *

Email *

Email confirmation *

Web Site (URL)

Ex : http://www.service-valorisation.com/page.html

Postal address

Number and Street *

Building, floor, door :

zip code *

Country *

Region

City *

Your technology transfer unit

The fields marked with an *must be completed.
Note: your email address will also be used to contact you but it is possible to enter an additional address for contact purposes if you wish.

Main Contact

Last name *

First name *

Position *

Email *

Email confirmation *

Phone *

Ex : 33 (0)1 12 32 54 68

You

The fields marked with an *must be completed.
Note: your email address will also be used to contact you but it is possible to enter an additional address for contact purposes if you wish.

University / School ...

University / School ...*

((Select at least one organism))

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Development areas

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I have read and agree to Expernova's terms of use *