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Thanks for you interest for the Gaselli ICT Entrepreneur Bootcamp : Silicon Valley. In order for us to collect some basic information from you and your company, please fill in the following information:

Company facts

Industrial sector within ICT: *

Size of the company: *

How many people, revenues/turnover of the company, fiscal year 2008, estimated fiscal year 2009, funding

When was the company established: *

Your Business

Short description of your company: *

Market need and potential, products/services, customers and customer segments, uniqueness, value proposition, growth potential and goals

Stage of the Company: *

Seed

Pre-Revenue

Growth

Revenue

Mature

Bootcamp

How do you see the Bootcamp being useful for you and your company? What are you looking for?: *

Information: Participant 1

Name:

Email:

Phone:

Short Bio / role in company (title):

Information: Participant 2

Name:

Email:

Phone:

Short Bio / role in company (title):