____________ View the challenge Closing date: ____________ There has been an error.Please ensure that this form is attached to a valid research license. Licenses Go back I have an account already General details Title: First name: * Surname: * Email address: * Contact number: Location: * Please select Option 1 Option 2 Option 3 Option 4 Option 5 Are you acting as a private individual? * No Yes Organization: * Please select Option 1 Option 2 Option 3 Option 4 Option 5 Organization: * Organization website Role: Organization type: Please select Option 1 Option 2 Option 3 Option 4 Option 5 I have read and agree to the Privacy Statement and consent to processing my data as described therein. Area(s) of interest Other area of interest Please add me to your mailing list so that I can receive the latest news and update from Shoots by Syngenta portal. You can unsubscribe at any time Please enter your one-time password: Please check your spam folder. If the one-time password doesn't come through, please contact shoots@syngenta.com or click here to resend the OTP. Licenses Select all licenses you wish to request: * Please provide any specific crops of interest (or type) Please share a brief non-confidential description of why you are interested in accessing the technology and how you intend to use it. * Will you utilize a third party transformation service to use the requested technology? * (A shared facility at your institution is not considered third party.) Yes No Additional comments Are you eligible to sign on behalf of your organization? * No Yes I don't know Provide details of the authorized representative if known, and / or the name of the department that we need to connect with. First name Last name Email Department Phone number Save as draft Request Licenses Review your license request Title Mr Full name John smith Email John@email.com Location London, United Kingdom Institution {Institution Name} Licenses: Specific crops of interest Description Will you utilize a third party transformation service to use the requested technology? Additional comments Are you eligible to sign on behalf of your organization? First name Last name Email Department Phone number I accept the terms and conditions Your email address has not been verified, please check your email and follow the instructions to verify your email. If you haven't received an email link, please check your spam or junk mail folders and if still not found, click on resend verification email. Please verify your email before submitting. You can save your progress by saving as a draft. Request licenses Continue editing Save as draft
