Entrepreneurship Night Entrepreneur Application

Application Instructions: Please complete the information below and submit it along with

your resume to shiran.aizik@startau.co.il with the subject "Entrepreneurship Night Application" by 16/1/12. If you have any questions regarding the application, please contact Oren Simanian orens@startau.co.il. We look forward to receiving your application. Fee: Upon acceptance you will be asked to pay a fee of 390 NIS, description below
Entrepreneur Contact Information
Name Phone number E-Mail Address Company Name

Venture field
What is the field of your venture? Choose an item Social Network/Internet Mobile Application Innovators for Technology Other: _____________

Background
Please write a few words about yourself including education/prior work experience and the entrepreneurs engaged in this venture.

Description
Write a short description about the need that the venture is designed to cope with.

Write a short description about how the venture is meant to solve the problem.

Write a short description about the venture, what you would tell investors.

Stage and investment

Please fill in the stage that your venture is in and the estimated amount of money required. Stage Please specify the amount of money invested in the venture if any (in $) Funding required (in $) Do you have a working prototype? Yes No Choose an item.

Have you presented this venture to venture capitalists or angel investors prior to this event? If so, list when and to whom you presented to.

Intellectual Property and Patent Registration

If your venture is patentable, please write the stage and type of patent Is venture patentable? Yes Please fill out the following :

Patent type that was submitted Countries that a patent request was submitted to When was the patent request submitted? Stage of patent request

Choose an item.

Click here to enter a date.

Our Policy
By submitting this application, I agree to meet the terms for the Entrepreneurs Night if accepted. Thank you for completing this application form and for your interest in Entrepreneurs Night.

What you will receive upon acceptance

The fee for Entrepreneurship Night is 390 NIS. This will include the following: BENEFITS
Lecture with Eyal Bar-Zvi Corporate Law Specialist Founding Partner BarZvi & BenDov Law Offices Lecture with Donna Abraham: How to present your ventureCommunication Specialist at Boyer Communication Group and Corporate Story Teller 5 minute presentation of your venture to a panel of investors and audience members with feedback Your company logo on our flyers

Cost (390 NIS)

Date and time

8/01/12 17:00

9/01/12 16:00

17/1/12 17:00