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BACC Affiliate Company Application
Contact's Telephone Number
Contact's E-mail Address
What year was the company founded?
Where are members of your team currently meeting?
What benefits would you receive from being an affiliate of the BACC?
Health Information Systems
Describe your products/services offered:
What makes your products/services unique and why will customers buy or use it?
Provide a list of the key technology development milestones to be worked on as an affiliate of the BACC and an anticipated timeline to achieve each of these milestones:
Provide three business references and/or vendors with name, address, and phone:
Check areas of assistance requested from BACC (select all that apply):
All information submitted in this document is considered to be non-confidential. Please DO NOT provide any information that contains or describes business secrets or other confidential information, as this document may be shared with third party reviewers.
I certify that everything I have stated in this application and attached to it is true to the best of my knowledge and the information provided in this application is accurate. I also understand my information will be shared with the members of the BACC Incubator Advisory Committees and the BACC will retain this application for their records.
Yes, I understand the above certification and disclaimer.
After submitting your application, you will receive a confirmation e-mail notifying you that it has been sent. Later you will receive an e-mail from BACC staff to whom you can send your business plan.
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