NYS Emerging Company Registration Application

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NYS Emerging Company Registration Application - Life Sciences Summit 2023

Thank you for your interest in the attending the Life Sciences Summit 2023 on October 11, 2023 in New York City. Please complete the following form with as much information as possible to be considered for a complimentary registration to the event. Emerging companies are qualified as having less than 10 employees and having their headquarters and main operations in NYS.

Please note there will only be one complimentary registration extended per company. Please DO NOT disclose confidential information in this form. Once the form is received a team member will be in touch. Questions? Please contact Center_for_biotechnology@stonybrook.edu.

Email *

Full Name *

Suffix

Academic Affiliation (if Applicable)

Company Name (If Applicable)

Company Type (if applicable - check all that apply)

Sole Proprietorship,

Limited Liability Company (LLC),

S-Corporation,

C-Corporation

Certified Women Owned

Certified Minority Owned

Certified Minority Veteran Owned

Other:

Company Website (If Applicable)

Title/Role within the company *

Phone Number *

Address *

Are there additional team members involved in your company/innovation? If so please let us know their names/roles.

Briefly describe your technology - Please only include non-confidential information. *

Is your technology disclosed/is there any intellectual property/are there any patents filed? *

At what stage of development is your technology? (Discovery, Proof-of-Concept, Pre-clinical, Clinical) *

What funding, if any, has supported your development to date?

If you currently have funding, what type of funding do you have (grant, seed, private, etc.)?

What are your future funding plans? *

Have you/are you currently receiving any assistance from accelerator programs/university programs/etc.? If yes, please explain. *

How did you hear about the Center for Biotechnology? *

Acknowledgement: I understand that submission of this does not guarantee the extension of a complimentary registration to the Life Sciences Summit 2023.Please initial below. *

Send me a copy of my responses.

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