BANTU Competition Application Form

• 1. Applicant Information
• 2. Application Form and Requested Documents

Applicant First Name *

Applicant Last Name *

Applicant Country *

Applicant Email Address *

How did you hear about Best Affordable New Technologies in Urology Competition? *
SIU Website
SIU eBlast
Friends
LinkedIn
Other (please specify)

Name / Title of the Device *

Application Form * Please download and print the following form and then upload it below. The applicant must sign the form at the end.

Project Owner Form * Please download the applicable form and upload it below once completed.
- Project Owner From for single owner
- Project Owner From for co-owner

Text Summary * A Summary is a text to give information about the project. It should include the title of the idea, the clinical problem it will solve and a summary of your project, opportunity and project objectives as well as the benefits of your project.

Also include the approximate number of patients who may benefit from this solution, the cost of the device, its applicability in rural areas.

Please write your summary in the box below.

Power Point Slides * The slides (10-15) should include the subjects in the Summary as “bullets” and drawings.

Please upload your Power Point slides below.

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