Application Form

centre for innovation & entrepreneurship

What programme are you interested in?
First name *
Last name *
Phone *
Email *
Job *
Organisation *
City *
Country *
How did you hear about LORA?
Portfolio website
Portfolio LinkedIn
Portfolio Twitter
Portfolio Facebook
What are your goals for the next 12 months? How will LORA help you get there?*
What are your expectations from the programme?*
As we review your application, is there anything else you would like us to know?*
Do you want to claim the 20% discount by registering with another Entrepreneur?[You can claim the discount once both of you have registered] Yes No
If yes, what is the name, surname and email address of the other Entrepreneur?*
Are you ready to move to the next level? Yes No Not sure
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