BIC Registration form

Basinghall Innovation Circle Onboarding
Dear Industry Partner

Welcome to the Basinghall Innovation Circle.

Below survey (no longer than 2 min) will give us a first overview on your interests and will help us to select interesting start-ups for you.

All information provided will be kept confidential and only used internally.

In case of any question, please do not hesitate to contact us via email hello@basinghallpartners.com.

Your Basinghall Innovation Circle Team
1. Contact Information
Company Name*
Company Website*
Please provide the full formatted address i.e. http://www.mysite.com
LinkedIn Profile Link (if any)
Contact Person*

First NameLast Name
Position*
Position held in the company
Contact Email*
example@example.com
Contact Phone Number
Date of Registration*

MonthDayYear
Date

Information Consent
I consent to Basinghall Partners using the information collected through this form*

YesNo
Should be Empty:

Basinghall Innovation Circle Onboarding