Registrant Type TCF Company Research Body Non-TCF Company Education Provider

Contact Name*: Position*:

Phone*: Facsimile*:

Email*: Website*:

Company Name*: ABN:

Address: Suburb: Post Code:

Country:

Postal Address: Suburb: Post Code:

Country:

Do you have a dedicated R&D section? Yes No

Number of R&D employees:

Estimated annual R&D spend ($A million) (optional):

I give permission for my contact details (marked with *) to be placed on the Australian TCF Technology Network website.

I acknowledge that my contact details (marked with *) will be provided to the Victorian Government under the terms of the contract establishing the network.
I agree to acknowledge the role of the network in any successful research activities undertaken or products commercialised.
I have completed both sides of this form.

PRIMARY ACTIVITIES

Please tick as many boxes as necessary to describe your operations

RESEARCH AND DEVELOPMENT INTERESTS

Please complete this section with as much information as possible.Network staff will contact you to discuss your needs
in further detail.

I am interested in the following:
Adaptation of technologies into existing TCF products.Please provide details:

Finding partners for the commercialisation of existing technologies.Please provide details:

Finding partners for early stage R&D in new technologies and/or products.Please provide details:

Identifying sources of funding for R&D and product development.Please provide details:

Please provide any additional information you feel would assist us in understanding your needs from the network (eg nature of technologies
or specific applications of technology,of interest to you) as attachments to this document.
All information remains confidential and upon request by yourself or at the conclusion of the project will either be destroyed or returned.