AI Consumer Registration – AIMEEX Marketplace

Section 1: Organization Information

Organization Name

Legal Entity Type:

Business Registration Number:

Country of Operation:

Address Field 1

Address Field 2

Company Website URL

Company LinkedIn Profile

Section 2: Primary Contact Information

First Name

Last Name

Job Title/Position

Department

Email Address

Phone Number

Username or Email

Password

Confirm Password

Section 3: Secondary Contact Information (Optional)

Full Name

Job Title/Position

Secondary Email Address

Phone Number

Section 4: Organization Profile

Brief Company Description

Primary Healthcare Services Offered

Number of Patients/Users Served Annually

Current Use of AI/Technology in Operation

Section 5: Areas of Interest for AI Solutions

Primary AI Use Case Need

Key Challenges Seeking to Solve with AI

Section 6: Compliance and Accreditation

Data Privacy and Security Standards Followed

Certifications Held by the Organization:

Compliance Officer Contact (Optional)