Apply to present your business at the Entrepreneurship Hub by completing the form below:

Personal Details
Full
Name(s): Title:

Address:
Street Address

City Postal Code

Email
Phone: :

Are you available to attend OECD

Eurasia Week, Economies in Motion:
From Strategy to Action, 17-19 March YES NO
2020? ☐ ☐

If selected, are you willing to submit a

short video to disseminate during OECD YES NO
Eurasia Week? ☐ ☐

Company Details

Company Acronym
Name: :

Address:
Street Address

City Postal Code

Email
Phone: :

Website:

Social
Media:

Other
Media
Coverage
:

Business Information

Industry or

1
sector:

How many years has your business been in operation: ☐ < 5 ☐ 6-10 ☐ > 10

☐ Profit ☐ Not-for-profit ☐
Business model:
Other:

Annual turnover: ☐ < GEL 30 000 ☐ < GEL 500 000 ☐ < GEL 1 500 000

Employment
☐ < 10 ☐ 10-50 ☐ 50-100 ☐ > 100
size:

Describe your business mission statement and the product/service provided by your company. (max 100 words)

Motivational Assessment

Please indicate the category of award that you wish to be considered for:

☐ Innovative Business Award - Businesses successfully exploiting new ideas to increase efficiency, improve
business processes, and/or bring new and improved products or services to market.

☐ Green Business Award - Businesses adopting an environmentally sustainable business model leading to better
use of resources, improved environmental technologies and/or reduced environmental impact.

Why should your business be considered for the Entrepreneurship Hub’s Innovative OR Green Business award?
(max 100 words)
* Please mention any relevant certifications, patents, awards, etc. that your firm may have obtained.

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3
 Who is the target audience of your business? Please describe your clients and/or customer base (max 100 words)

How does your business influence your operating environment e.g. community, region, etc.? Please describe the
impact your business exerts either directly or indirectly (e.g. through corporate social investment project,
environmentally sustainable supply chains, etc.) (max 100 words)

Which are the major challenges that you have had to face as an entrepreneur? What have been the key lessons
learned in setting up your business? (max 100 words)

Disclaimer and Signature

I hereby certify that the answers provided are true and complete to the best of my knowledge. I confirm that I am not
directly related to any of the organisers of the Entrepreneurship Hub and that any potential conflicts of interest have
been noted on this application form.
Dat
e: Signature: