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IEEE-USA Home: Entrepreneurs Village: TechMatch 2008

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IEEE-USA TechMatch 2008 Questionnaire

You can view a completed sample questionnaire in PDF format by clicking here.

Form

Name
Company
Address 1
Address 2
City
State
Zip
Email
Phone
Fax
Mobile

In less than 50 words, why should anyone fund my startup/company?

Description of technology:

Description of application(s):

Key team members:

Proprietary Nature and IP protection:

Background Information:

Stage of development:
Conceptual Proof of Concept Prototype Manufacturing Prototype Released
Regulatory issues:

Value proposition, target market(s), sizes:

Competitive landscape:

Funding summary – amount raised to date, current funding sought, and future capital requirements:

Revenue projections:

Customers/Partners:

Other comments:

Disclaimer - Please Scroll To Read & Agree By Checking The Box:
You are applying for participation in the IEEE-USA & LifeScience TechMatch 2008 Program. You understand that your submission of this application does not guarantee that you will be selected to participate in TechMatch 2008. In the event that you are selected, you understand that you may be required to agree to further terms and conditions prior to participation. By submitting this application, you agree that IEEE and LifeScience Alley (collectively, the “Hosts”) may use the information that you provide and disclose it to the participants and organizers of TechMatch 2008 in connection with processing your application and hosting TechMatch 2008. You agree that none of the information you provide in this application will be treated as confidential information, and you further understand that information you publicly disclose at TechMatch 2008 will not be treated as confidential information. The Hosts are not securities brokers/dealers or investment advisors, and they are not providing a securities exchange. The Hosts make no representations or warranties with respect to TechMatch 2008, including, but not limited to, the qualifications of the participants and the information, products or services that they provide. You are encouraged to conduct your own due diligence in assessing the representations made by participants in TechMatch 2008. The Hosts cannot guarantee and do not promise any specific results from your participation in TechMatch 2008. In no event shall the Hosts, their affiliates, sponsors, officers, directors, agents, employees and any parent or subsidiary companies be liable to you for any direct, incidental, indirect, special, punitive or consequential damages, including, but not limited to, damages arising from any type or manner of commercial, business or financial loss occasioned by or resulting from your application to participate and/or participation in TechMatch 2008, even if the Hosts had actual or constructive knowledge of the possibility of such damages and regardless of whether such damages were foreseeable. You hereby release and waive any claims, and agree to hold harmless the Hosts and their affiliates, sponsors, officers, directors, agents, employees, any parent or subsidiary companies and all other applicants and participants in TechMatch 2008 against any claims, arising from or that are or could be asserted with respect to any matter relating to your application to participate and/or participation in TechMatch 2008. You further agree to indemnify, defend and hold the Hosts harmless from any and all damages, liabilities, fees and costs incurred in defending against any third party claims or threats of claims arising from your application to participate and/or participation in TechMatch 2008.

I have read & agree to the TechMatch 2008 disclaimer above.

Updated: 14 April 2008
Contact: Scott Grayson, s.grayson@ieee.org

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