Advanced BioEntrepreneurship Workshop South Africa,

6 & 7 December 2011, Cape Town Confidential

Application Form

Important notes:

-  Do fill in the form as far as possible at your current status: Not everything must be defined yet

-  Do not exceed the indicated number of pages (4 pages maximum)

Name: Title, First Name, Name
Contact: E-Mail, Phone (Mobile)
University / Company:
Registration: Student (semester), PhD, professor
Equity status: Black / White
Gender: Male / Female
Project name: Company or project name
Short description of your project: Short description (4-6 rows)
Web: www.mycompany.com (if available).
Type of business: biotech, service provider, contract research, …
1.  BioEntrepreneurship or business management course completed
Please specify which programme you attended and from which institution.
2.  Entrepreneurial profile and motivation (1 page max)
Show us, why you will succeed as an entrepreneur!
What are you motivations to be an entrepreneur?
3.  Project description (2 pages max)
Provide a compelling executive summary of your business idea at this stage!
Research / technology / novelty / Intellectual Property (IP):
What kind of technology are you using / developing? What is novel about it? What kind of IP protection have you secured? Do not disclose proprietary information!
Status:
What is the status of research and development of your technology / product? What can you say about “business development” activities?
Problem:
Which market problem / opportunity do you plan to address?
Product / service:
What kind of product or service will you offer?
Target customers:
Who will benefit in which way from your solution / market offering? Who will buy it?
Team:
Who else is or will be involved in the product and business development / future company?
4.  References / Experts (1/2 page max)
Provide names and contacts (email, phone) of suggested external references and experts!
Who would be prepared to tell us more about your personal skills as a potential entrepreneur? Who are the experts (technology, industry and market) in your field, who could help you to develop your business? And who do you plan to involve to get feedback and advice?

For more information, contact:

(form adopted from venturekick c/o IFJ Institut für Jungunternehmen)