Early Stage East - Venture Capital Showcase for the East Coast

December 8^th & 9^th
Nassau Inn, Princeton, NJ

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

Resume Saved Application

General Information

Company

Address 1

Address 2

City

State

Zip

Contact First Name

Contact Last Name

Phone
() -

Fax
( ) -

Website URL

Discount Code

Credit Card Information

Credit Card
This is a secure page.

Credit Card #
Application Fee: $195.00

(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 & Titles

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

Company

Title

Job Description 250 characters

Employment History

Start Date / End Date

Company

Title

Job Description 250 characters

Team Member 4

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

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
$

Date of Funding

Use of Funds 250 character max

Source 2 250 character max

Amount of Funding
$

Date of Funding

Use of Funds 250 character max

Source 3 250 character max

Amount of Funding
$

Date of Funding

Use of Funds 250 character max

Company Profile

Business Description 250 character max

Company Description 250 character max

Product Line or Service 250 character max

Technology/Proprietary Rights 250 character max

Market Opportunities 250 character max

Marketing/Sales and Distribution 250 character max

Manufacturing 250 character max

Competition 250 character max

Financial Information (actual and projected)

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)

Reference 1

Name

Company

Phone

Nature of Relationship with Company

Reference 2

Name

Company

Phone

Nature of Relationship with Company

Reference 3

Name

Company

Phone

Nature of Relationship with Company

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