First Name:*

Last Name:*

Company:*

Phone:*    (e.g. 123.456.7890, 123.456.7890 x123)

Mobile Phone:    (e.g. 123.456.7890, 123.456.7890 x123)

Email Address:*

Website URL:    (e.g. http://annarborusa.org)

Address:*

City:*

State:* AB AK AL AR AZ BC CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MB MD ME MI MN MO MS MT NB NC ND NE NF NH NJ NM NS NT NV NY OH OK ON OR PA PE QC RI SC SD SK TN TX UT VA VT WA WI WV WY YT

Zip:*

Current Full Time Employees:*

BUSINESS IDEA INFORMATION:
It is understood that business ideas will be lacking in one or more of the following areas. Please provide as much information as is available. Each text box is limited to 250 characters.

Description of the Product or Service & Problem it is Solving:
Describe the product or service to be sold by the company and the customer problem that it solves (i.e., the need). Do you know potential market size?*

Development Activities:
What is the status of the development of the product or service? What are the near term activities and key milestones that are required for the development of the product or service? Are there any key alliances necessary?*

Managerial and Development Team:
Describe briefly the role of current participants and give their relevant background to their ongoing involvement in the product development or proposed company.*

Financial Plan:
Describe any funding to date, the dollar amount, use of the funds, and the source.*

How many seats do you need?*

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