10941_BioTechX US_Start-Up Application

BioTechX USA

Start-up Application Form
Please complete this booking form to confirm your participation in the Start-Up Zone at BioTechX USA.

On receipt of this booking form, your company will be isssued with an invoice.

Our payment terms are 30 days.

Pricing: $750 + VAT
Contact Name*

First NameLast Name
Job Title*
Company*
Email*
example@example.com
Mobile Number*

Area CodePhone Number
Billing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Accounts Payable Name

First NameLast Name
Accounts Payable Email
example@example.com
Accounts Payable Phone Number*

Area CodePhone Number
Year you were established?*

MonthDayYear
Date
Number of Employees*

5-1010-5050+
Level of funding*

SeedSeries ASeries BOther
Short Company Description*
Company Logo*

Cancelof
Will you also be interested in joining BioTechX Europe 2025?*

Yes
Should be Empty: