CII Startupreneurs Expo 2017

Registration Form for Startups

Startups Information

Required fields are marked with *

Name of your startup *

Email id *

Website URL *

Current turnover(if any) *

Facebook *

Full name of the primary contact person *

Phone Number *

Inception Date *

Location *

Youtube Video Link *

Product / Service Information

Required fields are marked with *

Which industry do you carter to *

AutomobilesBFSIConsumer DurablesSteel & PowerRetailTelecom
Pharmacy & HealthcareOil & GasIT & ITeSHospitalityInfrastructureOthers
Manufacturing and EngineeringMedia & EntertainmentWellnessConsultingAerospace & Defense

How many team members does your startup have *

1-33-55-10>10

Brief background of founder(s) - Please provide split up of roles if more than one founder *

Why do you want to participate in the expo ? (for eg: get funding, seek advice etc) *

What is the current status of your venture? *

Idea StagePaying Customer
PrototypeCustomer Revenue Growth
R&D CompletedPilot done

Describe your funding requirements ( if any )? *

Have you raised any external funding, how much(INR)? *

Describe your product/service *

How does your product/service help address the pain points? *

What differentiates your product/service from current competitors and how you will sustain your advantage? *

Any additional information you would like to provide? *

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