The Venture Club of Indiana features one 10-minute spotlight presenter at each regular monthly luncheon. Applicants are reviewed by a Committee before being selected to present. Below is the information the Committee requires in order to make an informed decision. Please answer each question to the best of your ability.

*Denotes Required Fields

Company Name:*

Web Site Address:*

Three Sentence Description of the Business*

How did you learn of the Venture Club of Indiana's Spotlight Presenter program?*

Any previous experience with VCI?* Yes No

Stage of Development - check as many as apply* Concept Entity Formed (date formed) Intellectual Property Developed Full-Time Management Team Prototype Developed Whole Product / System Developed Product Launched in the Market Paying Customers Gross Margin Positive Cash Flow Positive

Market: Description, size, planned penetration and timing.*

What unmet need in the market does the business serve?*

What regulatory or other approvals are needed to get the product or service in the market?*

Capitalization Amount and source of capital funding to date.*

Pre-money valuations at each of your previous investment rounds, and currently.*

Current capital being sought, and use of these funds.*

Anticipated additional capital needs beyond current round.*

Management Team and Key Advisors Name:* Role:* Relevant Experience:* E-mail Address:* Full Time?:* Yes No Start Date:* Name: Role: Relevant Experience: E-mail Address: Full Time?: Yes No Start Date: Name: Role: Relevant Experience: E-mail Address: Full Time?: Yes No Start Date: Name: Role: Relevant Experience: E-mail Address: Full Time?: Yes No Start Date: Name: Role: Relevant Experience: E-mail Address: Full Time?: Yes No Start Date: Name: Role: Relevant Experience: E-mail Address: Full Time?: Yes No Start Date:

Intellectual Property Please provide brief description, as well as stage of development.*

Who is your direct competition?*

Supporting Documentation If available, please attach an executive summary (2 pages maximum) and PowerPoint slide deck (10 slides maximum ). Include contact information for business key contact person.

Executive Summary: PowerPoint Slide Deck:

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*Denotes Required Fields