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13th Annual Investment Conference for Private Companies
April 9, 2007
World Trade Center Boston

CorporateSponsors:	Organizational Sponsors:
DLA Piper Nutter, McClennen & Fish PricewaterhouseCoopers Levine, Katz, Nannis & Solomon	Angel Capital Association Mass Tech Transfer Center

Application Form Deadline - Wednesday, February 21, 2007

I. Instructions: Select the appropriate fee based upon your company status and Mass Technology Leadership Council membership. Complete the remainder of the application form and then press the "Proceed to Next Step" button at the bottom of the form for further instructions.

Note: All fields in BOLD are required.

Presentation Fee: If you are already a MassTLC Member, please make a selection under "Council Members". If you are not currently a Council Member, please make a selection under "Non-Members". If you have any questions pertaining to the status of your membership, please contact Heather Johnson at 617.437.0600 x28 or heather@masstlc.org

PLEASE NOTE: An Emerging company is defined as a company that has been started in the past twelve months and has five or fewer employees. All other companies are considered Standard. For emerging non-member companies, presentation fee also includes a Council Membership through 2007.

Presentation fee includes attendee fee for presenter, three prep sessions and a demo station at the conference.

NEW THIS YEAR: Networking table for non-presenting companies wishing to host a demo table (for 60 minutes)!

Council Members
	$500 -- Standard Company Presentation Fee (Current Council Member)
	$400 -- Emerging Company Presentation Fee (Current Council Member)
Non-Members
	$750 -- Standard Company Presentation Fee (Non-Member)
	$550 -- Emerging Company Presentation Fee (Non-Member)
Demo table (new category)
	$150 -- NEW! Demo table only (for 60 minutes) (Member)
	$200 -- NEW! Demo table only (for 60 minutes) (Non-Member)

II. Company Information
Company Name:
Presenter First Name:
Presenter Last Name:
Gender:	Male Female
Presenter Title:
Presenter E-Mail Address:
Presenter Bus. Telephone:
Presenter Mobile Phone:
Presenter Fax:
Secondary Contact:
Secondary Contact Title, Phone, Email:
Company URL:
Corporate Mailing Address:
Additional Registrants: ($100 each)
Total # Addtl. Registrants:

III. Business Information Company Industry (Primary) Select One):
	Software Products/Applications	Communications Products/Services
	Software Services	Wireless Products/Applications
	IT Services	Bio/Health-IT
	Nanotechnology	RFID/Distributed Sensors
	Energy	Social Media
	Open Source	Robotics
Company Industry (Secondary) Select One:
	Software Products/Applications	Communications Products/Services
	Software Services	Wireless Products/Applications
	IT Services	Bio/Health-IT
	Nanotechnology	RFID/Distributed Sensors
	Energy	Social Media
	Open Source	Robotics

Please give a one or two sentence elevator pitch that will be used in our promotional materials:

How did you hear about our 2007 Investment Conference for Private Companies?

How are you currently funded?

What round of financing are you looking for?

How much capital are you trying to raise?

Do you have a business plan?	Yes No
Do you have any customers to date?	Yes No
If you have any questions, please call the Council at 617-437-0600 x13 or email melissa@masstlc.org You will receive a confirmation email upon our receipt of the application form and check. Press the 'Proceed' button below to submit your application and to receive instructions for mailing your payment by check.