Hartpury Tech Box Park Membership Application Form

Tech Box Park Membership Application

To apply for membership please complete all questions.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

PostalCountry
Business Name *

Business Address

Street Address

CityState / Province

Postal Country
E-mail*
example@example.com
Mobile*
Work Number*
Website
LinkedIn
Business Type*

Limited CompanySole TraderPartnershipCICLimited Liability Partnership
UTR/Company Registration Number*
How many people do you employ?*
Please tell us about your business and elaborate on the current stage of your growth journey:*
Please tell us about your new or existing innovative products/services. Please share your thoughts about how you see them adding value to the agriculture sector:*
What industry do you work in?*

Manufacturing/ProductionAgriculture/FoodEnvironmental/EnergyHealth/Community and social servicesResearch/EducationRetail/MarketingConstruction/EngineeringTech/Digital/CyberPharmaceuticalOther
If other, please elaborate
What do you hope to get from working within the Hartpury Tech Box Park & Barclays Ecosystem Partnership Programme?*
Which of the following is of interest to you and your business: (Tick all that apply)*

Support with R&DNetworking and eventsPartner/collaboration opportunitiesGrant funding/application supportWorkspace/desk/unit rentalAccess to testing and trialling sitesSupport with marketing and promotionAccess to a new market (agriculture)Hire of event/demonstration/meeting spaceData analytic skills and expertiseMentoringStudent engagement/workplacement/KTP/PhDSupport with finance, strategy, business OperationsSupport with environmental sustainability/net zeroTo gain a better understanding of the Agriculture sectorOther
What is your gender? (Optional)*

MaleFemaleNon binaryAnother gender identityPrefer not to say
What is your ethnic group? (Optional)*

Asian or Asian BritishWhite BritishBlack, Black British, Caribbean or AfricanNon binaryAnother gender identityPrefer not to say
Which best describes your sexual orientation? (Optional)*

Straight or hetrosexualBisexualGay or lesbianPansexualAsexualAll other sexual orientationsPrefer not to say
Do you have any physical or mental health conditions or illnesses lasting or expected to last 12 months or more? (optional)*

YesNoPrefer not to say
Should be Empty: