Mentor's Form
Complete this form if you would like to join The Microfluidic Circle community as a mentor.
All information provided will be kept confidential unless disclosure has been consented.
Full name *
Your answer
Email address *
Your answer
LinkedIn profile URL *
Your answer
Organization *
Your answer
Job title *
Your answer
What is your area of expertise? *
Your answer
Once your relationship with the mentee grows, you may evaluate opportunities for more in-depth involvement with the ventures. At what capacity are you interested to be involved? *
Required
What provided information would you like to be published on the Circle website? *
Registered startups will use this information to choose their mentor. That is why we would like to ask for your permission to publish as much details about you as possible in order to make your profile highly informative for the startups.
Required
The Microfluidic Circle would like to send you updates about Mentors-Startups program. Please confirm your acceptance to receive emails from Circle:
You can change your mind at any time by contacting us at circle@ufluidix.com. We will treat your information with respect. For more information about our privacy practices please visit our website. By submitting this form, you agree that we may process your information in accordance with these terms.
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