Elanco Technology Acquisitions SUBMISSION Form

Please fill in the following information.

* Denotes a required field

* First name:
* Last name:
Company/Organization Name:
Position:
Telephone number:
* Your e-mail address:
Website URL :
Mailing address:
City:
State:	- Select - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
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* Your innovation relates to:	- Please Select - Companion Animals Food Producing Animals Both groups of animals
Please provide some background about yourself, and your organization:	- Please Select - Company/Corporation Governmental Agency Individual Inventor Professor/University Other
* Please provide a non-confidential description of your technology or molecule, and what disease condition it is intended to address: