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2019 PFG Application Form

Biotech Innovation Showcase & Forum

April 30 & May 1, 2019
FFA Enrichment Center
1055 SW Prairie Trail Pkwy
Ankeny, IA 50023

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(Updated on Mondays)

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1:1 Meetings

Sponsors

Hotels

The application deadline has been extended to January 18th!

Up to twelve (12) emerging biotech companies will be selected to present on April 30, 2019 and compete for the $5,000 prize. Companies will be notified by early February to confirm if they have been selected to present. Thank you for your interest!

For more information about the application process and event, please review our Frequently Asked Questions page. If you have an immediate questions, please contact Melissa Moyer at melissa@iowabio.org or 515-327-9156.

* denotes a required field.

Contact Information

First Name: *
Last Name: *

Job Title: *

E-mail: *

Phone: *

Company Information

Company Name: *

Website URL: *

Company Logo: *

(jpg,png,jpeg)

Company Address: *

(Street, Suite, City, State, Zip)

How Long Has Your Company Been in Existence?: *

Number of Employees: *

(Company-Wide)

Have You Raised $100,000 or More?: *

Yes

Summary of Company Revenues for the Last Three Years: *

(50 words or less)

Are You Seeking Investment Capital?: *

Yes

If You Listed "Yes" Above, Please Indicate How Much:

Upload Your Financial Projections: *

(doc,docx,pdf,xls,xlsx)

Upload a Copy or Summary of Your Business Plan: *

(doc,docx,pdf)

Upload the Names and Biographies of Your Mangement Team Members: *

(100 words or less per Team Member)

(doc,docx,pdf)

Upload the Names and Biographies of Your Significant Advisors: *

(100 words or less per Adviser)

(doc,docx,pdf)

Technology / Research Topic

Name of Your Technology or Research Topic: *

Upload an Executive Summary of Technology/Research Topic: *

(250 words or less)

(doc,docx,pdf)

Is Your Technology Still in the Development Stage?: *

Yes

Is Your Technology Commercialized?: *

Yes

Additional Feedback

Have You Given a Pitch to 250 or More People?: *	Yes No

Please Enter Any Additional Comments or Feedback: (Optional)

Payment Information

Product Quantity Price Subtotal

Payment: *

Application Fee ($125.00)

Price:

Subtotal:

Total Amount Due:

Billing Information

Credit Card Type: *
Credit Card Number: *
Card Security Code: *	(What is this?)
Expiration Date: *

First Name: *
Last Name: *
Company Name:
Address: *
City / State / Zip: *