Maharashtra Health Impact ForumRegistration

Registration

Choose your track and complete the form. Participation is confirmed after review.

DelegateAttend the workshop, with an optional Day 2 field trip StartupApply to pitch in one of three themes

01 Your details

Your name will be printed on your badge exactly as entered here.

Full name *In English, as on your government ID.

Designation *

Organisation *

Organisation type *

Email *

Mobile number *

+91

Used for OTP login to check status and download your badge.

City *

State *

02 Your interest

Themes you are most interested in *

MedTech Climate Change & Health Maternal Health

What do you hope to take away from the forum? *Two or three sentences. This helps the organising team review your registration.

03 Day 2 field trip, Alibag

On 14 November delegates travel to Alibag to observe last-mile healthcare delivery. Seats are limited and confirmed separately.

Would you like to join the Day 2 field trip? *

Yes, register me for Day 2 No, Day 1 only

04 Declarations

I confirm that the information provided is true and accurate. Aadhaar declaration. I understand that if I am selected to be part of the workshop, I will be required to log in to this portal with my mobile number and OTP and update my Aadhaar details for identity verification and venue access, before my badge is issued. I consent to the organisers processing my personal data for the purpose of managing my participation in the forum.

You will receive a reference number on the next screen.

Pitch Challenge. Three startups in each theme will be invited to pitch. The winning startup earns the opportunity to conduct a study within the Living Lab ecosystem for up to 100 participants, free of cost.

01 Startup and founder

Startup name *

Website

Applicant full name *The person who will pitch. In English, as on your government ID.

Designation *

Email *

Mobile number *

+91

Used for OTP login to check your application status.

City *

State *

Team size *

02 Registration status

Tell us how your startup and product are registered.

Is your startup a registered legal entity? *

Year of incorporation

CIN / LLPIN / registration number *

Recognised by DPIIT (Startup India)? *

Yes Applied No

Product regulatory status *

Regulatory details

03 Your solution

Pitch category *

MedTech Climate Change & Health Maternal Health

Solution / product name *

Current stage *

One-line description *

What problem does it address? *

How does the solution work? *

Who is the intended user? *

Where does it fit in the care pathway? *

04 Validation in the Living Lab

Which assumptions still need to be tested in primary-care or last-mile conditions? *

If you win, what study would you conduct with up to 100 participants? *Describe the question, who would participate and what you would measure.

Evidence generated so far

Link to pitch deck or product videoA view-only link (Drive, Dropbox, YouTube). Optional but recommended.

05 Declarations

I confirm that the information provided is true and accurate, and that I am authorised to apply on behalf of this startup. The solution described is our own work and its presentation will not infringe the rights of any third party. I accept that the decision of the evaluation panel is final. Aadhaar declaration. I understand that if I am selected to be part of the workshop, I will be required to log in to this portal with my mobile number and OTP and update my Aadhaar details for identity verification and venue access, before my badge is issued. I consent to the organisers and evaluators processing the information in this application for the purpose of the Pitch Challenge and the forum.

You will receive a reference number on the next screen.

Registration

Registration received