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of the Year Growth and Expansion Leader of the Year in Home Care Gynecologist of the Year Health & Wellness Visionary of the Year Health Coach of the Year Health Education Leader of the Year Health and Wellbeing Leader of the Year Healthcare Advocacy Leader of the Year Healthcare Compliance Leader of the Year Healthcare Education Leader of the Year Healthcare Finance Leader of the Year Healthcare Influencer of the Year Healthcare Innovation Leader of the Year Healthcare Leader of the Year Healthcare Marketing Leader of the Year Healthcare Marketing Strategy Leader of the Year Healthcare Mentor Leader of the Year Healthcare Regulatory Affairs Leader of the Year Healthcare Researcher of the Year Healthcare Scientist of the Year Healthcare Staffing Leader of the Year Healthcare Technology Integration Leader of the Year Healthcare Technology Leader of the Year Healthcare Technology Visionary of the Year Healthcare Visionary of the Year Healthcare Woman of the Year Herbal Solutions Leader of the Year Holistic Healer of the Year HR of the Year Infertility Specialist of the Year Inspiring Healthcare Leader of the Year Inspiring Psychologist of the Year Integrative Medicine Leader of the Year Innovative Healthcare Leader of the Year Inventory Controller of the Year Medical Devices Leader of the Year Medical Innovation Leader of the Year Mental Health Leader of the Year Mental Wellness Leader of the Year Nonprofit Leader of the Year Nutritionist of the Year Performance Coach of the Year Preventive Healthcare Leader of the Year Public Health and Safety Leader of the Year Pulmonologist of the Year Regulatory Affairs Leader of the Year Sleep Physician of the Year Spiritual Health Leader of the Year Spiritual Wellness Leader of the Year Sports Nutrition Leader of the Year Sports Performance Leader of the Year Strategic Leader of the Year Telemedicine Leader of the Year Translational Medicine Leader of the Year Wellness Visionary Leader of the Year Other Select your Category / Award Title Clinical Research Innovation of the Year Education and Placement Leader of the Year Other Select your Category / Award Title Emerging Skincare product of the year Neurocosmetics Innovator of the Year Product Innovation Leader of the Year Other Select your Category / Award Title Andrologist of the Year Cardiologist of the Year Cardiothoracic Surgeon of the Year Consultant Psychiatrist and Senior Physician of the Year Diabetologist of the Year Emergency Physician of the Year ENT Surgeon of the Year General Surgeon of the Year Gynecologist of the Year Minimally Invasive Surgeon of the Year Neurosurgeon of the Year Oncologist of the Year Oncologist Surgeon of the Year Ophthalmologist of the Year Orthopedic Surgeon of the Year Pathologist of the Year Physician of the Year Plastic Surgeon of the Year Urologist of the Year Other Select your Category / Award Title Behavioral Healthcare Leader of the Year Counsellor of the Year Innovative Mental Health Idea of the Year Mental Health Care Center of the Year Mental Health Leader of the Year Mental Health Professional of the Year Mental Health Promoter of the Year Mental Health Startup of the Year Mental Wellness Leader of the Year Psychologist of the Year Psychotherapist of the Year Other Select your Category / Award Title Ayurvedic Physician of the Year Energy Medicine Practitioner of the Year Holistic Healer of the Year Holistic Nutrition and Lifestyle Program of the Year Holistic Wellness Leader of the Year Integrative Medicine Leader of the Year Lifetime Achievement in Natural Medicine Metaphysician of the Year Midwife of the Year (Wellness and Holistic Care) Spiritual Wellness Leader of the Year Wellness & Herbal Solutions Leader of the Year Wellness Leader of the Year Wellness Mentor of the Year Wellness Visionary of the Year Yoga Coach of the Year Other Select your Category / Award Title Bio-Technology Leader of the Year Biomedical Innovation Leader of the Year Clinical Research Innovation of the Year Molecular Biologist of the Year Pharma Company of the Year Pharma Distributor of the Year Pharma Innovation Organisation of the Year Pharma Retail Chain of the Year Product of the Year (including contraceptive) Scientist of the Year Translational Medicine Leader of the Year Other Select your Category / Award Title AI Dermatology Start-up of the Year AI Leader of the Year in Health and Social Care Healthcare Technology Integration Leader of the Year Healthcare Technology Leader of the Year Healthcare Technology Visionary of the Year Medical Device Leader of the Year Medical Tech Organization of the Year MedTech Leader of the Year Neurotechnology Company of the Year Non-Invasive Healthcare Device of the Year Telemedicine Leader of the Year Telemedicine Services Company of the Year Technology Leader of the Year in Healthcare and Wellness Other Select your Category / Award Title Dental Clinic of the Year Dentist of the Year Digital Restorative Dentist of the Year Facial Surgeon of the Year Maxillofacial Prosthodontist of the Year Oral Health Promoter of the Year Restorative Dentist of the Year Young Dentist of the Year Other Select your Category / Award Title Clinical Nutrition Leader of the Year Dietician of the Year Fitness Leader of the Year Fitness Mentor of the Year Fitness Solution Expert of the Year Health Coach of the Year Nutritionist of the Year Performance Coach of the Year Protein Snack of the Year Sports Nutrition Leader of the Year Sports Performance Leader of the Year Other Select your Category / Award Title Innovative Health & Wellbeing Programme of the Year Innovative Healthcare Leader of the Year Innovative Idea of the Year Innovative Medical Product of the Year Innovative Pain Management Program of the Year Innovative Solutions Leader of the Year Innovative Wellness Product of the Year Most Innovative Product of the Year in AYUSH Product of the Year (all sectors) Other Select your Category / Award Title CBO of the Year CEO of the Year CIO of the Year CMIO of the Year CISO of the Year COO of the Year CTO of the Year Chief Audit Executive of the Year Chief Product Officer of the Year Managing Director of the Year President of the Year Other Select your Category / Award Title Emerging Healthcare Startup of the Year Emerging Tech Company of the Year Entrepreneur of the Year Health & Wellness Entrepreneur of the Year in Healthcare Founder of the Year HealthCare Start-up of the Year Healthcare Entrepreneur of the Year Visionary Founder of the Year Well-being Startup of the Year Wellness Entrepreneur of the Year Young Healthcare Entrepreneur of the Year Other Select your Category / Award Title Community Health Impact Leader of the Year Disability Inclusion Leader of the Year Diversity Leader of the Year Global Impact Leader of the Year Public Healthcare Initiative of the Year Social Change Leader of the Year Social Impact Leader of the Year Sustainability Leader of the Year Other Select your Category / Award Title Care Services Leader of the Year Chiropractor of the Year Growth and Expansion Leader of the Year in Home Care Long-Term Care Provider of the Year Nursing Coach of the Year Nursing Recruitment Centre of the Year Osteopath of the Year Physiotherapist of the Year Podiatrist of the Year Speech Language Pathologist of the Year Other Select your Category / Award Title Business Leader of the Year Constructive Healthcare Leader of the Year Director of the Year Executive Healthcare Leader of the Year Growth and Expansion Leader of the Year Strategic Leader of the Year Strategist of the Year Visionary Leader of the Year Other Select your Category / Award Title Clinical Mentor of the Year Educator of the Year Education & Placement Leader of the Year Healthcare Education Leader of the Year Healthcare Mentor Leader of the Year Mentor of the Year Skincare Training and Education Leader of the Year Spiritual Education Leader of the Year Other Select your Category / Award Title Aesthetic & Wellness Center of the Year Aesthetic Consultant of the Year Aesthetics Skincare Director of the Year Anti-Aging Product of the Year Cosmetic Plastic Surgeon of the Year Cosmetologist of the Year Dermatologist of the Year Emerging Skincare Product of the Year Natural Ingredient Skincare Product of the Year Skin Expert of the Year Other Select your Category / Award Title Finance Leader of the Year in Healthcare Healthcare Compliance Leader of the Year Healthcare Finance Leader of the Year Healthcare Regulatory Affairs Leader of the Year Inventory Controller of the Year Lab Director of the Year Lifetime Achievement in Healthcare Governance Quality & Patient Safety Leader of the Year Regulatory Affairs Leader of the Year Supply Chain Professional of the Year Other Select your Category / Award Title Emerging Medical Communications Leader of the Year Healthcare Influencer of the Year Healthcare Marketing Leader of the Year Healthcare Marketing Strategy Leader of the Year Marketer of the Year Marketing Company of the Year Other Select your Category / Award Title Biomedical Innovation Leader of the Year Clinical Research Innovation of the Year Data Scientist of the Year Healthcare Researcher of the Year Healthcare Scientist of the Year Neuroscience Expert of the Year Other Select your Category / Award Title Executive Women of the Year Healthcare Visionary of the Year Lifetime Achievement Award Lifetime Achievement in Natural Medicine Most Inspiring Leader of the Year Posthumous Lifetime Achievement Award Visionary of the Year Young Healthcare Leader of the Year Young Wellness Visionary of the Year Youngest Wellness Visionary of the Year Other

What makes you or your organization a strong fit for this award? *

Key Achievements in the Past 12 Months * Select Key Achievements in the Past 12 Months Innovations Partnerships Revenue Growth Social Impact

Achievements in Media & Recognition * Select Achievements in Media & Recognition Awards Received Media Features Notable Recognition

Links (articles, interviews, videos, etc.) *

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Number of People / Teams You Lead * Select Number of People / Teams You Lead 1 - 10 11 - 50 51 - 200 201 - 500 501 - 1,000 1,001 - 5,000 5,001 - 10,000 Above 10,000

Mentorship or Industry Contributions * Select Mentorship or Industry Contributions Yes No

Community or Social Impact Initiatives (brief description 50–100 words)

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Global / Regional Presence (Country Operated In)* Select Global / Regional Presence Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Saint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos Islands Colombia Comoros Cook Islands Costa Rica Croatia Cuba Curacao Cyprus Czech Republic Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Ivory Coast Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Republic of the Congo Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu U.S. Virgin Islands Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican Venezuela Vietnam Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe

Key Partnerships or Collaborations

Vision for the Next 3 Years *

Are you open to:*

Speaking Opportunities * Select Speaking Opportunities Yes No

Media Features * Select Media Features Yes No

Brand Partnerships * Select Brand Partnerships Yes No

Serving as Jury Member * Select Serving as Jury Member in Future Editions Yes No

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Forttuna Global 100 * Select Forttuna Global 100 Yes No www.global100.forttuna.com

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Industry Focus / Keywords *

Annual Marketing Budget * Select Annual Marketing Budget <$1M $1–10M $10–50M $50M+

Do you Make Purchasing/Investing Decisions? * Select Decision-Making Role Yes No

Interest in Sponsorships or Partnerships * Select Interest in Sponsorships or Partnerships Yes No

Company Growth Goals * Select Company Growth Goals Branding Expansion Funding New Market Entry

Target Markets for Expansion * Select Target Markets for Expansion Antarctica Australia and New Zealand The Caribbean Central Africa Central America Central Asia East Asia Eastern Africa Eastern Europe Global / Multi-Regional Melanesia Middle Africa Micronesia North America Northern Africa Northern Europe Polynesia South America South Asia Southeast Asia Southern Africa Southern Europe The Arctic Western Africa Western Asia (Middle East) Western Europe

Professional interest * Arts / Media / Culture Education Entrepreneurship Finance Health & Wellness Innovation Philanthropy Public Policy Sustainability Technology Other

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Consent to Be Featured in Forttuna Media & Partner Publications * Select Consent to Be Featured in Forttuna Media & Partner Publications Yes No

Consent for Photo/Video Use During Awards * Select Consent for Photo/Video Use During Awards Yes No