Canada's Top 10 Competition

Canada's Top 10 Application Form

Closing date for applications is August 21, 2010

* Mandatory field

Corporate Information

Corporate Information

* Company Name:
* Mailing Address (line 1):
Mailing Address (line 2):
* City:
* Province:
* Postal Code:
* Telephone: ext.
Fax: ext.
Website: http://

Contact Information (This is the person actually submitting the application)

* Name:
* Position:
* Telephone: ext.
* Email:

Application For: (Please select the appropriate competition)

Life Sciences
Cleantech
Technology

Section 1 - Company Profile

Company Profile

* Please provide a brief description of your company (maximum 1000 characters)
* President & CEO:
* CFO:
Year of incorporation:
* Number of employees:

Section 2 - Management Team

Board of Directors

* Please provide name, title and organization name for each of your board members. (maximum 1000 characters)

Management

* Please provide name and title for each member of your management team. (maximum 1000 characters)

Advisory Board/Network (if applicable)

Please provide name, title and organization name for each of your advisory network members. (maximum 1000 characters)

Section 3 - Financial Highlights

Assets & Liabilities

* (maximum 1000 characters)

Expenses & Income

* (maximum 1000 characters)

Current investors & funding received

* (maximum 1000 characters)

Section 4 - Milestones

Milestones

* Please provide important product development milestones within the next 2-3 years (maximum 1000 characters)

Section 5 - Technology/Product or Service Offering

Technology/Product or Service Offering

* Please provide a brief description of your company's platform technology, product or service offering. (maximum 1000 characters)

Section 6 - Market Outlook

Market Outlook

* Please provide a brief description of the industry for and the application of your product including reference to the size of the market, expected market growth, differentiation, and competitiors (maximum 2000 characters)

Section 7 - Go to Market Strategy

Go to Market Strategy

* Please provide a brief description of your go to market strategy including any current or prospective customers, partners and distribution channels (maximum 2000 characters)

Section 8 - Additional Information

What type of investment are you looking for?

* Type and amount of Investment sought: (maximum 1000 characters)
* Plans and timing for exit: (maximum 1000 characters)

Additional Comments

Comments: (maximum 2000 characters)

You may not submit the form until all mandatory information has been entered

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