Global Agetech Innovations Lab Professional/Innovator Member Profile/Application
This profile will be used by the leadership of the GAIL in order to assist in the best matchmaking possible with other members of the lab.  Please be as specific as possible on all questions.  If more information is needed, the leadership team will send you an email in order to request as such.  
Email *
Company Name: *
Company's website if applicable:
List any social media pages for this company here:
How many employees does your company currently have?
Has your company already went to market with your product/service?  If so, can you please give information on when it went to market and how it is going?

If not, when do you plan to go to market?
Name of person completing form and title: *
Name and title of representative for lab to communicate with: *
Contact Person's Email: *
Contact Person's Phone Number: *
What is your company's mission?
Please explain in a short summary what service or product you are developing/developed and how it applies caregiving and/or older adults? *
What is your NUMBER ONE goal for joining the GAIL? *
Required
Check any and all interests for joining the GAIL? *
Required
Virginia Tech's Center for Gerontology is now offering a 100% virtual Graduate Certificate in Leadership for an Aging Society that can be completed within 2 semesters (1 year) or longer as needed for working professionals.  Would you or would someone that works for your be interested in enrolling for this type of program?  Choose all that apply: *
Required
Please choose from the list below all of the assets in which you have TO OFFER other members of the GAIL:  (ISO=In Search Of) *
Required
Would your company be willing and able to pay an annual membership fee of $500 for this membership? (this is not binding, membership fees will be collected after membership is accepted.  You will be notified via email of membership status after completing this profile) *
Would you like to be included in a social media/newsletter/blog new member announcement? *
Any other information you would like us to know more about your company and/or mission?  Please enter it here:
Who else do you know that you can share GAIL's mission and they would help us grow and become a stronger collaborative network?

Please enter their emails below and they will receive a personal invite from you to join the GAIL.  Enter as many as you would like.
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