Presenter Application
Early-Stage Life Sciences Technology Conference XIII
Please complete this application form, rename this document to “YourCompanyName_LS_2017_Presenter_Application” and save as a Word format.
Submit it to the Massachusetts Technology Transfer Center to
If you are accepted to present at the Conference, the section Company / Technology Profile of this form will be published in the Conference Notebook, which will be distributed to potential investors and partners and posted on the MTTC website.
Applicant Information:First Name, Last Name
Title
Phone
website
Technology Transfer Office Information:
(This section only needs to be completed if the company’s core technology has been licensed from a research institution or is in the process of being licensed.)
Institution name
Contact Name
Contact e-mail
Date License Executed (or expected to be executed)
Scientific Co-Founders:
Names and Institutional Affiliations
Technology/Product Information:
Industry Segment e.g. Diagnostics, Drug Delivery, Genomics and Proteomics, Therapeutic -Cardiovascular
Funding
Amount of Private Capital or Grant funding already secured and the sources of this funding
Company / Technology Profile
* Optional fields - to be completed only if applicable
Company name*
Company logo*
Research Institution Affiliation*
Contact Information (if different from Applicant Information)
Please provide contact person name, title, phone, E-mail, website.
Date Company was established*
Officers and Directors*
Employees*: Full Time: # or 0, Part Time: # or 0, Contract: # or 0
Principal Investors*
Company Overview* (150-200 words)
In this section please describe the vision for the company; company’s core technology and planned product(s); and brief management backgrounds and their areas of expertise.
Product/ Technology Profile (400-500 words)
In this section you should include information on the following areas:
Product(s)/Technology
In this subsection please describe your product/technology and identify what unique problems or needs your product/technology will address.
Market and Application
In this subsection please describe the addressable market and include the current and/or potential size of the market.
Commercial Opportunity
In this subsection please describe target customers and how you plan to market to them.
Competitive Advantages
In this subsection please explain how the market is currently dealing with the problem and outline your sustainable competitive advantage.
Future Financial Plans
In this section please provide information about requested funding, anticipated use and milestones that will be reached with the funding.
Company/Technology Confidential Information
If confidential information about your company/technology might be helpful in the selection process, please submit this information here. The information will NOT be published in the Conference Notebook.