Florida Venture Forum



MEMBERSHIP APPLICATION
2010 Early Stage Venture Capital Conference

Ventures Newsletter

In the News

Previous Event Presentations

7/29/2010
Florida Venture Forum Revises Date of 2010 Early Stage Capital Conference

5/25/2010
Daniel H. Aronson Re-joins Florida Venture Forum

5/25/2010
Kovaleski to serve on Enterprise Florida’s Stakeholders Council

5/25/2010
Young to join the Florida Venture Forum Board of Directors

4/14/2010
Florida Venture Forum Names Lockheed Martin Executive, Vernon E. Williams to Board of Directors

Other Forum News

Florida Venture Forum, Inc.
Friends of the Forum
Membership Directory Benefits

You are invited to participate in the Florida Venture Forum’s annual Friends of the Forum Membership Directory, a listing of individuals and companies from the entrepreneurial community who support the Forum and are active in Florida’s economic growth and development.

The following levels of sponsorship are available:

I. AFFILIATE SPONSORSHIP	$ 1,000.00
v Complimentary registration for two (2) representatives at the statewide monthly Forum programs throughout 2010. v Company listing, logo and description (50 words or less) in the Friends of the Forum Directory. v Participation as a panelist or moderator at a selected monthly Forum programs. v $50 discount towards the early registration fee of $499 for the annual Florida Venture Capital Conference. v Tabletop Display opportunity at all monthly programs.
II. FRIEND OF THE FORUM SPONSORSHIP	$ 500.00
v Complimentary registration for one (1) representative at the statewide monthly Forum programs throughout 2010. v Company listing in the Friends of the Forum Directory.
III. UNIVERSITY MEMBERSHIP	$ 250.00
v Complimentary registration for one (1) representative at the statewide monthly Forum programs throughout 2010. v Company listing in the Friends of the Forum Directory.
IV. ENTREPRENEURIAL COMPANIES*	$ 150.00
v Complimentary registration for one (1) representative at the statewide monthly Forum programs throughout 2010. v Company listing in the Friends of the Forum Directory. *For entrepreneurs with less than $1 million annual revenue (service providers and investors are not eligible).

APPLICATION

Instructions: Please complete the following online application and submit. If sending through US Mail or by fax, print and send information in hard copy to: MAIL APPLICATION AND PAYMENT TO:

Florida Venture Forum, Inc.
P.O. Box 961
Tampa, FL. 33601

TELEPHONE: (813) 335-8116
FACSIMILE: (888) 375-7136

• Primary Name:

Title:

Secondary Name:

Title:

• Company:

• Type of Company:(Please check one of the following)
Entrepreneurial Company
Indicate if:
Marketing/Sales
Finance/MIS
Engineering
Operations/Manufacturing
Human Resources
Research & Development
Executive Management
Annual Revenue: (Entrepreneurial Companies)

Entrepreneurial
Indicate industry:
Communications & Networking
Electronics & Computer Hardware
Software & Information Services
Medical/Healthcare Services
Medical Devices/Biotechnology
Retail/Distribution/Consumer Prod.
Service Businesses
Other

Professional Service Provider
Indicate if:
Attorney
Accountant
Human Resources
Computer/MIS
Other Consulting Service

Source of Capital
Indicate if:
Venture Capital
Investment Banker
Private Investor
Other

Non Profit Support Group

University

• Street:

• City:

• State

• Zipcode:

• Telephone:

Fax:

• Email:

Website:
http://

• Select Sponsorship (Select only One)
$1,0000.00 for my Affiliate Sponsorship-Enclosed is a brief description of my company (no more than 50 words) and a camera-ready black and white copy of my company logo.
$500.00 for my Friends of The Forum Sponsorship and listing only.
$250.00 for my University Level Sponsorship (or Non-Profit)
$150.00 for my Entrepreneurial Companies with annual revenue less than $1 Million. (Service Providers are not eligible)

$500.00 to place a Friends of the Forum directory Ad
(Note: must be an existing member. To complete this action please check another membership level)
Please e-mail Ad to pat@floridaventureforum.org
Ad Specs: Ads for the Friends of the Forum directory need to be 5.35w x 7.125. Black & White (JPEG@300 dpi) Quark 5.0 or 6.0 with fonts and pictures included, PDF files or illustrator files with outline fonts.

• Payment Type:

Card Number:

Expiration Date: (MM/YY or DD/MM/YY)

Name as it appears on the card:

If paying by VISA or Mastercard, please enter the V Code as it appears on the back of your card.:
(The last 3 numbers.)
If paying with American Express, please enter the CID#.:
(4-digit number on the front of your card.)

Company Valuations: What is my company worth and how is that determined?
Wednesday, October 13, 2010
5:30PM-8:00PM

Reading Vital Signs – How emerging healthcare trends and legislation will affect market performance
Thursday, October 14, 2010
5:30PM-8:00PM

The Americas Venture Capital Conference
Wednesday, November 17, 2010

Fifth Annual CEO Forum
Wednesday, December 1, 2010
11:00AM-5:00PM

The University of Tampa Florida Directors' Institute Program
Monday, December 13, 2010

Florida Companies to Watch (SM) Awards Celebrate Dynamic,
Thursday, February 17, 2011

View Calendar