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December 8th & 9th
Nassau Inn, Princeton, NJ
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Presenter Application

Bio-Life-Tech 2009 is accepting applications for companies seeking their first and second rounds of institutional funding to participate in the exclusive Healthcare & Life Science Venture event for the leaders of the Mid-Atlantic region.

Companies must attend the Mandatory Coaching Session on November 19th if they are selected to present.

APPLICATION FEE: $250.00
(This includes the Keynote Speaker & Dinner on December 8th. Please note that the credit card will only be charged if your company is invited to present)

Companies MUST apply online. To apply please complete and submit the form below:

Early Stage East 2010 Application

Secure
Resume Saved Application
Companies must be referred by a Venture Capitalist or Investor
Reference Name:
Referring Organization:
Referrer Email:
Referrer Phone:
Referrer Address:
 
 
Company:
Address 1:
Address 2:
City:
State:
Zip:
Contact First Name: MI:
Contact Last Name:
Phone: ( ) -
Fax: ( ) -
Email:
Website URL:
Credit Card: This is a secure page.
Credit Card #:    Application Fee: $500.00  Help
(Do not enter dashes or spaces)
CVC:
Expiration date: /
Cardholder's name:

All applications must have credit card information.
Your credit card will only be charged if you are accepted to present.

Management Team & TitlesHelp

At least two members of the management team must be identified. For each member, you must complete
at least one Employment History, with all fields included. There is a 250 character maximum for all job descriptions.

Team Member 1
Name: Title:
Employment History Start Date / End Date
Company: Title:
Job Description   
250 characters
Employment History Start Date / End Date
Company:Title:
Job Description   
250 characters
Employment History Start Date / End Date
Company:Title:
Job Description   
250 characters

Team Member 2
Name: Title
Employment History Start Date / End Date
Company: Title:
Job Description   
250 characters
Employment History Start Date / End Date
Company: Title:
Job Description   
250 characters
Employment History Start Date / End Date
Company:Title:
Job Description   
250 characters

Team Member 3
Name: Title:
Employment History Start Date / End Date
Company:Title:
Job Description   
250 characters
Employment History Start Date / End Date
CompanyTitle
Job Description   
250 characters
Employment History Start Date / End Date
CompanyTitle
Job Description   
250 characters

Team Member 4
Name Title
Employment History Start Date / End Date
CompanyTitle
Job Description   
250 characters
Employment History Start Date / End Date
CompanyTitle
Job Description   
250 characters
Employment History Start Date / End Date
CompanyTitle
Job Description   
250 characters

Company History
Year Founded
Number of Employees
Cash Funding to Date $
Bank
Auditor
Law Firm
Industry
Other
Amount of funding sought $
Current Investors

Funding
Source 1
 250 character max
Amount of Funding $
Use of Funds
 250 character max
Date of Funding
Source 2
 250 character max
Amount of Funding $
Use of Funds
 250 character max
Date of Funding
Source 3
 250 character max
Amount of Funding $
Use of Funds
 250 character max
Date of Funding

Company Profile
Business Description
 Help250 character max
Company Description
 Help250 character max
Product Line or Service
 Help250 character max
Technology/Proprietary Rights
 Help250 character max
Market Opportunities
 Help250 character max
Marketing/Sales and Distribution
 Help250 character max
Manufacturing
 Help250 character max
Competition
 Help250 character max

Financial Information (actual and projected)Help

Please note that negative figures should be denoted with a "-", and cutting and pasting data may cause problems submitting the application.

  2009 2010 2011 2012 2013
Revenue $ $ $ $ $
*EBITDA $ $ $ $ $
Pre-tax Income $ $ $ $ $
Net Income $ $ $ $ $

*Earnings before interest, taxes, depreciation and amortization

References

(If no references exist, please enter bogus data into fields or application form will not submit)

Name Company Phone Email Nature of Relationship with Company
1.
2.
3.


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