First & Last Name! 

Email 
Create Startups Showcase Account  (optional)  

U.S. Phone Number or Google Voice Number 

Startup Company Name 

Your Startup Logo - Link to your company Logo 

One Sentence Intro of Startup "Tag-Line" e.g. Aplaz is the expert HR department for Startups and SMB's!" 

YouTube or Video Link - "2 minute PITCH about your Startup" 

When did you LAUNCH your Startup?  In Stealth Mode Less than one year More than one year

How is your Startup Funded? Click all that apply. 
Potential Investors are eager to know your commitment(s) to date! Boot Strapped Convertible Note Safe-Note Seed Investment (Family-Friends-Fans) Angel Round A-Round B-Round C-Round Other

How much is invested in your Startup "TO DATE"? 
Please Check all that apply. $1k to $5k $6k to $10k $11k to $20k $21k to $50k $51k to $100k $101k to $500k $501k to $1.1MM $1.2MM to $5MM $5.1MM to $10MM $10.1MM to $30MM Other

Does your Startup have Revenue?  No Revenue $5k to $50k $51k to $100k $101k to $250k $251k t0 $500k $501k to $1MM $1.1MM to $5MM $6MM to $11MM Other

Startup Category 
Please Check all that apply. Gaming B2C B2B2C Sports / Fitness Consumer Consumable Hardware Social Networking Entertainment Utility Education Location Based Mobile Commerce Lifestyle B2B Other

Web url, App url or App Store 

Supported Platforms? 
Web, iOs - Driod Native.. etc. Web-Page-App Food Clothing Wearable Tech iOS Droid HTML5 Windows8 Black-Berry-Rim Web-Site Life Science Hardware Other

How did you hear about this event? 
Please check all that apply. Startups Showcase Facebook Twitter Meetup LinkedIn Other

How much are you Raising for your startup?  $25,000 - $100,000 $100,001 - $250,000 $250,001 - $500,000 $501,001 - $1,000,000 $1,000,001 - $3,000,000 $3,000,001 - $5,000,000 $5,000,001 to $10,000,000 Other

Startups Showcase Participation Fee is $150.00. 
*you can pay online at the eventbrite link below or we will accept cash at the event. https://www.livesharkstank.co