Application to Present at SIEGE 2021 Investment Conference
Your application will be distributed to panelists, advisors and others on or before the day of the conference. Please call Rob or Lynn Hassett at 678-506-8828 if you have any questions. We will continue to accept applications until we have selected 8 Presenting Teams.

LEGAL DISCLAIMER
THE INFORMATION IN THIS APPLICATION AND IN ANY OTHER DOCUMENT AND ANY INFORMATION APPLICANT PROVIDES IN OR IN CONNECTION WITH APPLICANT’S PRESENTATION AT THE 2021 SIEGE INVESTMENT CONFERENCE ARE FOR INFORMATIONAL PURPOSES ONLY AND DO NOT CONSTITUTE A SOLICITATION OR OFFER TO SELL OR PURCHASE SECURITIES. IN THIS REGARD, IT IS UNDERSTOOD THAT THE SIEGE INVESTMENT CONFERENCE IS PRIMARILY AN EDUCATIONAL EVENT.
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Company Name *
Title of Project
Contact Name *
Contact Email *
Contact Phone *
Contact Address
Development Stage (ex: Startup or Revenue Generating or Profitable) *
Year Founded *
Management Team: Names and Titles *
Funding Sought
Planned use of funds, listed as a percentage used for: Product Development; Marketing/Sales; Operation/Inventory; Existing Debt; Legal/Other *
Current Monthly Burn Rate *
Current Monthly Revenue *
Current Investors
PROBLEM/OPPORTUNITY: What problem does your business intend to solve? What opportunity does your business plan to exploit? Why have others not addressed it before? *
BUSINESS SUMMARY: This is a 1-2 sentence summary of your business, NOT your development project. Highlight the mission of your company. *
TARGET MARKET: How large is the market, where is it and who are the customers?
COMPETITION: Describe your competitors and how you are positioned relative to them. What is your unique competitive advantage? *
PRESENT POSITION - What has your business accomplished thus far? Describe what development has been completed to date including answers to the following questions: 1. Do you have a mockup, working or not working prototype or saleable product? 2. Do you have designs and/or specifications? 3. Do you have any flowcharts or mind maps illustrating any aspect of your development plans or services offered? 4. Is coding needed? What is your state of progress in completing coding? 5. Where are you with testing? None? Alpha? Beta? Product ready for sale? Product being sold? Results? 6. What feedback have you received from testing, surveys or similar activities? 7. Have you had any purchasers/customers? If so what feedback have you received? *
SALES CHANNEL: Describe the channel you (intend to) use to sell your product. (App Store, Steam,Google Play store, self-publish /direct sales, etc.) *
CUSTOMER ACQUISITION STRATEGY: Describe how you will acquire your customers. *
INTELLECTUAL PROPERTY: Have you applied to register any trademarks or service marks?  If yes, provide the mark and place of filing and whether or not it has been registered and, if not, the current status of the application to register.  Have you applied for or do you own any patents that are currently pending or have been registered in any country? If so, list here:  Have you applied for or do you own any registered copyrights? If so, list here: *
FINANCIALS: Show revenue, costs, and profits for up to 3 prior years and projections for 3 future years. *
OFFER TO INVESTORS: What percentage of your company are you planning to sell to investors and how much are you trying to raise for such percentage?
MANAGEMENT TEAM: Describe the core management team including their names, addresses, relevant work experience and any other information that you believe investors would want to know. *
ARE YOU ELIGIBLE FOR THE "BEST STARTUP" IN THIS COMPETITION? Any such company will not have received investments of more than $ 25,000 including investments by founders, and their friends and family, and outside investors? Additionally, revenue from the prior calendar year and revenue to the date of submission in the current fiscal year, must not have exceeded $ 25,000. *
Mentoring: Please check all that apply
RIGHT TO USE: By completing and submitting this form and/or any responses, the Applicant, and individuals submitting this on behalf of  Applicant, represent and warrant that the material submitted may be provided to and reviewed by individuals who participate in the conference or otherwise are given copies, that any and all participants in making a presentation at the conference understand and agree that their appearance in the conference may be recorded and/or streamed, that any recordings may be streamed later and that their name and/or image may be used as part of or to promote any future investment conference or successor investment conference.It is understood that the use of your name in any submission you make of this document shall be deemed to constitute submission with your written signature. *
Required
SUBMITTED MATERIAL NOT CONFIDENTIAL: Any person submitting material for use in connection with the SIEGE INVESTMENT CONFERENCE acknowledges and agrees that the material submitted is not confidential. You should not submit any material you wish to have remain confidential. *
Required
PRESENTING IN PERSON OR VIRTUALLY: You will be permitted to give your presentation in person at Axis Replay or via Zoom. Free breakfast and lunch will be offered to up to three members of each Presenting Team who attend in person.  Subject to limitations on how many people the venue can accommodate, you may elect to change your choice up to one week prior to the event.  We reserve the right to make the entire event virtual.Unless you notify us otherwise at least one week prior to the conference, you will present (insert an X to provide your preference): *
Required
AUTHORITY: Any individual who signs this application on behalf of a Presenting Team and/or a related entity represents and warrants that such signatures is made with full authority and is binding on any entity and the individual members of the Presenting Team. *
Required
Name of Submitting Individual (providing your name here                                                                                                       constitutes your signature)
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