Competition Registration

     Please complete this registration as thoroughly as possible. Required information is in bold. The information provided will register your business concept in this program. Team information can be updated by the team leader at any time. Upon completion, all team members will receive an e-mail with their User Name, Password and information about the team.
 
General Team Information:
 
Team/Company Name:   
Business Concept:   
 
Industry (Check all that apply):














Competition Track:

Please select a competition category. Categories can be changed until the deadline for submissions.

Competition Categories:
 
Venture Drive
Your venture's initial Vision/Traction Organizer uploaded by November 12, 5 p.m.

All awards will be presented on Thursday, May 7, 2015 at the Michigan Celebrates Small Business event in Lansing..
 
Eligibility:
 
 1. Does at least one member of your team live, work, or go to school in Michigan?
    
 2. If your team/company exists as a legal entity(example: Corporation or LLC), please click here to answer a few questions about your company.

  How long have you been in operation?
   


  Are you registered in the state of Michigan?
 
 
 3.  Is your business idea/concept a subsidiary of an existing business?
 
 4.  What is the approximate cumulative amount of revenues to date? Then, describe what the source of the revenue is  (Do not include grant income).
Amount:  $   
Description:  

 5. Please state the total amount of funding, where the funding came from and a little description of why you received the money:

FundingAmountSourceDescription
Institutional Investors (VCS)
Loans
Other 3rd Party (friends, family, angels)
Grant Funds (include brief description and title of grant sources)

 6. Is your venture incorporated (registered in any state as an LLC or corporation)? If yes, what was the date of formation? (Month/Year)
 
 
 
 7. Is your venture operating under a DBA? If yes, what was the date of the DBA filing? (Month/Year)
 
 

 8. Have you, or do you plan to be, incorporated in Michigan? (Month/Year)
 
 

 9. How many full time employees/contract workers do you have as of today's date (include founder)?
 
 

 10. As of today's date, what dollar amount of venture capital or angel investment do you have?
 
 

 11. As of today's date, what dollar amount in grants have you received?
 
 

 12. As of today's date, what dollar amount in loans have you signed for?
 
 
 
Team Members:
    
Teams are required to have at least one team member. You can be a single-member team by creating your user ID and account and selecting yourself as the Team Leader. Each team must select a Team Leader. You can add team members below by creating new individual accounts on the left OR adding existing members with a user ID on the right (you will need their account User Names to use this option). If you have a account, simply use your User Name in the right-hand column to add yourself to the team. The new members you enter are not officially created until the complete competition application form is submitted. The Team Leader will receive an e-mail notice of the new member accounts that are set up and confirmation of your registration in the competition. 
 
Add a New Member to Team:
Add an Existing Member to Team:
User Name: 
 

Current Team Members:
 
There are currently no members on your team.
 
   
Choose the statement that best describes the composition of your team:




 
 
 
 
City:  
 
 
 
 (xxx-xxx-xxxx)
Phone(Secondary): (xxx-xxx-xxxx)
(xxx-xxx-xxxx)
  
Coaching Request:

  If you would like to apply to receive a coach or mentor, click here to specify which skills and industry experience you are looking for.

 SkillsIndustry Experience
  
























  Please signify in under 50 words what help you desire from a coach or mentor.
 

  Coaches will be matched with a team based on the following preliminary 10-question assessment. Please answer the following ten questions:

QuestionAnswer
What is the opportunity you are capitalizing on; the problem you are trying to solve; or the need you are trying to fill?
Briefly describe the product or service you will offer.
How is your product better than any existing products or other developing technologies?
What are the barriers to solving this problem now?
How will you overcome these barriers?
How big do you think the market is? Do you have data to support this?
Who is your customer (who will be writing you the checks for payment)?
Who are your major competitors?
How far along are you?
a. Sites with some development still needed.
b. Fully functional sites in the hands of potential customers.
c. Already could be selling to paying customers and have been approached.
Who is on your team and what other help do you need?

Additional Information:
 
  How did you hear about the competition? (check all that apply)



Word-of-Mouth 
Talk / Presentation 
Previous participant 
Other 
 
  If you have a relationship with any of the MiQuest board, staff or organizers, specify below.
 
 
Participant Agreement:

Please read the Participant Agreement below. If you accept it, acknowledge by picking 'I Accept' from the drop-down menu below the agreement.

By registering to participate as a competitor in this MiQuest program, you grant MiQuest, and its affiliates and assigns, the right to print, publish, broadcast, and use, worldwide in any media now known or hereafter developed, including but not limited to the World Wide Web, at any time or times, your name, portrait, picture, voice, likeness, biographical information, and all other information provided on your registration form as news or information and for promotional purposes without additional consideration.

You understand and acknowledge that MiQuest, its board members, officers, sponsors, judges, coaches, and organizers are volunteers and are under no obligation to render any advice or service to you or any other competitor. The views expressed by these people are their own and not those of MiQuest.

As a registered participant, you take sole responsibility for protecting your rights or the rights of third parties in any intellectual property involved in the business described in submitted business plans. You also take sole responsibility for determining whether any third party has rights in any such intellectual property, notifying any such third party of inclusion of any disclosure of that intellectual property in a submitted business plan, and obtaining any necessary permissions from such third party. Further, you are cautioned that disclosure of intellectual property in your submission may compromise or destroy those rights. MiQuest is not responsible for the content of any submitted business plan or protection thereof, including disclosures relating to intellectual property.

You further understand, acknowledge, and agree that although the organizers of the competition will take reasonable steps to preserve the confidentiality to the concepts, ideas, and potential trade secrets contained in materials submitted as part of the competition, none of the board members, officers, sponsors, judges, coaches, and organizers of MiQuest are or will be liable for any loss, damage, or cost you may suffer by reason of the disclosure of these concepts, ideas, or trade secrets, the legal protection of which are your sole responsibility. Accordingly, and in consideration of the time and effort provided by such persons, you release and discharge each such person from any such loss, damage, or cost relating to or arising out of any such person's participation in the competition.

 
Please print this form for your records before submitting this form.