Company Name*

Company Street Address*

Contact person*

Contact E-Mail Address*

Contact Phone Number*

Additional Attendee Name

Additional Attendee E-mail Address

Additional Attendee Phone Number

Description of your business*

2012 Revenue*

2013 Revenue Projections*

Industry*

— Advanced Manufacturing Advanced Transportation Agriculture Alternate Energy Communications Education Engineering Environment Food Safety Green Technology Lifestyle Life Sciences Medical Device Physical Product Software Other

Year Established*

Amount investment raised, if any*

Past Participant in (check all that apply)*
 GLEQ Accelerate Michigan Michigan Growth Capital Symposium ACE Elevator Pitch ACE Exhibit Table None Other
If Other please explain

Are You Interested in Participating in the Elevator Pitch (must advise by Monday, January 14)*
 Yes No

Do you have any special requirement to exhibit your product/service?

Do you need electricity?*
 Yes No

Why do you want to exhibit at ACE?*
 Funding Customer Looking for Team Member Networking Other
If Other please explain

Applicant Signature*

Date (MM/DD/YYYY)*

*Acceptance:
By supplying your digital signature and checking the accept box you verify that the information your provided is accurate and that you represent the business for which you are registering.

Human Verification


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