Form

First name*

Last name*

Email*

Phone number

Gender*

Age range*

Current highest qualification on NFQ*

County of Residence*

Company Name*

Company Address*

Company County*

Parent Company Name (if applicable)

Parent Company Address (if applicable)

Occupation*

Business Type*

Sector*

If other selected please specify here:

Average Number of Employees

Number of years in business*

Brief description of your product/service?*

What sector are you looking to target?*

What innovation areas are you looking to address?*

What is your capacity to scale up quickly to take on a significant client?*

How did you find out about Innovation Exchange?*

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Dublin BIC's Privacy Statement

Skillnet Ireland Privacy Statement

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