AI2V New Jersey
Event Registration
June 9-12, 2008
NJIT campus, Newark NJ
AI2V New Jersey, 2008
The four-day January workshop is followed by eight weeks of weekly 1-hour teleconferences or strategy sessions with coaches and mentors.

Contact the NCIIA if you experience difficulties: 413-587-2172 or email info@invention2venture.org
*First Name:
*Last Name:
*Your Email:
Honorific:
Position (Job Title):
*Institution (Company):
If your institution is not listed in the
pulldowns above, please enter it here:
           
Department:
Industry/Status:
*Address:
*City:
*State:
*Zip Code: -
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*Telephone:
Fax:
Website:
About Your Startup:
What is the name of your startup? *
Please provide a brief summary about your startup opportunity (500 words or less).
About Your Team:
Please provide brief team member bios here.
Team Member 2
Please provide the full name, address, phone number and email for team member 2
Team Member 3
Please provide the full name, address, phone number and email for team member 3
Team Member 4
Please provide the full name, address, phone number and email for team member 4
Registration:
Registration Selection
6/13 SBIR Workshop
You and your team are invited to attend Sharon Ballard's SBIR workshop on Friday, 6/13. There is no registration fee for AI2V participants ($95 value per person). More information about the workshop will be available shortly. Please let us know how many members of your team would like to attend.
1 2 3 4 We/I cannot attend
Total Form Charges:
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Check
Make payable to: NCIIA
Mail to: 100 Venture Way, Hadley, MA 01035
Purchase Order
Purchase Order Number:
Special Arrangement
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Credit Card (complete information below)
Credit Card #
Expiration Date
Name on Card
(Exactly as it appears on your card.)
Billing Zip Code
(For the credit card's billing address.)
V-Code Where is my v-code?
(Last 3/4 digits on the back of card.)
(All participants) I agree to the photo and video release terms below *
Photo and video release
I hereby grant the NCIIA, The Lemelson Foundation and the Smithsonian Institution and their respective successors and assigns, and the NCIIA hereby accepts, a non-exclusive, perpetual license to use my name and image for promoting the NCIIA and its mission, including without limitation, use in websites, print media, television advertisements, and any other media or in any other manner as determined by the NCIIA. (If you do not wish to grant this license to the NCIIA, please call the office at (413) 587-2172.)