Date:

Name:
                  Last                               First                               Middle

Company:

Address:
                      Number                      Street                                                        City                                      Country                           Postal Code

Telephone # Mobile Phone #

Email Address:

Website:

Please indicate which industry sector you are interested in (e.g., petroleum, manufacturing, etc.)

Please indicate which country you are interested in (check any that apply):
Libya:   Switzerland:    Mali:    Tanzania:    Turkey:    USA:  

Please describe in detail your business proposal:

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