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Early $tage East - The Initial Venture Capital Showcase for Promising Young Companies
2002 Conference
The ESE 2002 Bio-Tech-Life
Conference will be held
October 9th in Wilmington,DE

2002 Conference Info
Now accepting applications
for companies seeking their
first and second rounds of
funding from the fields of
biotech, life science,
pharma and the related
techological fields

Sponsorships are selling fast!
Sponsor Now!
Conference
Attendee Information
Sponsorship
History / Press Room
Applicants
Benefits/Criteria
Application Info
Application Process
Submit Application
News & Noteworthy
2002 Sponsors Update
2002 ESE Re-Cap
Sign Up for Membership
3 Mill Road, Suite 201A, Wilmington, DE 19805, ncarig@earlystageeast.org P: 302.777.2460, F: 302.777.1620
conference Attendee Information Sponsorship History / Press Room Applicants
 

Application

APPLICATION FEE: $395.00

Companies MUST apply online.
For credit card orders only. Complete and submit the form below. Confirmation will be provided via e-mail. If not paying by credit card, be sure to send a check, as no applications will be processed until further payment is received.

Mail payments to:

Early Stage East
Three Mill Road
Suite 201A
Wilmington, DE 19806

For assistance in completing this application, it may be helpful for you to reference information provided by previous participants. For a link to three of our award winners from last year, click here.

Early Stage East 2002 Application

Referred by
Referring Organization

Other

Company
Address 1
Address 2
City
State
Zip
Contact First Name MI
Contact Last Name
Phone () -
Fax () -
Email
Website URL
Credit Card  
Credit Card #    Application Fee: $395.00
(Do not enter dashes or spaces)
Expiration date /
Cardholder's name

If you are accepted your credit card will be charged $395.00


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.

Management Synopsis
Please provide a one paragraph summary of management team with relevent positions, accomplishments and awards.
Team Member 1
Name Title
Employment HistoryStart Date / End Date
Company      Title
Job Description    
Employment HistoryStart Date / End Date
Company      Title
Job Description    
Employment HistoryStart Date / End Date
Company      Title
Job Description    


Team Member 2
Name Title
Employment HistoryStart Date / End Date
Company      Title
Job Description    
Employment HistoryStart Date / End Date
Company      Title
Job Description    
Employment HistoryStart Date / End Date
Company      Title
Job Description    


Team Member 3
Name Title
Employment HistoryStart Date / End Date
Company      Title
Job Description    
Employment HistoryStart Date / End Date
Company      Title
Job Description    
Employment HistoryStart Date / End Date
Company      Title
Job Description    


Team Member 4
Name Title
Employment HistoryStart Date / End Date
Company      Title
Job Description    
Employment HistoryStart Date / End Date
Company      Title
Job Description    
Employment HistoryStart Date / End Date
Company      Title
Job Description    

Company History

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

Funding

Source 1
Amount of Funding $
Use of Funds
Date of Funding
Source 2
Amount of Funding $
Use of Funds
Date of Funding
Source 3
Amount of Funding $
Use of Funds
Date of Funding

Company Profile

Business Description
Company Description
Product line or service
Technology/Proprietary Rights
Market Opportunities
Marketing/Sales and Distribution
Manufacturing
Competition

Financial Information (actual and projected)

2000 2001 2002 2003 2004
Revenue $ $ $ $ $
*EBITDA $ $ $ $ $
Pre-tax Income $ $ $ $ $
Net Income $ $ $ $ $

*Earnings before interest, taxes, depreciation and amortization
Please report all numbers in thousands (000's)

References

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

Applicants will be notified by August 29, as to whether or not
 your company was accepted to present or exhibit.

 
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