Team Name *

Company / Organization Name: *

Nature of Organization: (select one) *

Team Leader Name: *

Postal Address:

Title

Location: *

phone number

Email

website

Team leader Headshot:

Link to video:

Team leader Bio: *

Team Story: *

Team Group Picture or science picture:

Other Team member names:

Institution Affiliation:

Approach: *

Other:

How did you hear about the challenge?*

Are you looking for funding?

Do you agree to allow The Palo Alto Prize and partner organizations and sponsors, to publish and promote the information shared in this form for marketing/PR opportunities? *

By submitting this Intent to Participate, you hereby agree and understand that you are only expressing an interest to participate in the Palo Alto Prizes and that you are not yet registered in the competition. You acknowledge and agree that submission of an Intent to Participate application or expression of interest in any of the Palo Alto Prizes does not entitle you to any right to or claim on any of the Palo Alto Prizes or the prize organizers and does not create any legally binding obligation on the part of the prize organizers to you. Qualified contestants must first go through a due diligence process before they are accepted into the competition. The terms and conditions with respect to the Palo Alto Prizes will be set forth and agreed to by the parties signatories thereto in a separate written agreement called the Master Team Agreement or a similar written agreement. *

Submitted by:

DATE Submitted *