NCN at ExpoEast/Shark Tank/Company Listing Application/September 2012

1. Application to be listed as a company seeking investment at ExpoEast

Each year Nutrition Capital Network leads a session at ExpoEast for qualified investors with an interest in nutrition and health & wellness companies. As part of this orientation, NCN distributes a list of Expo exhibitors that are seeking capital, partnership or exits, complete with booth numbers and a contact name. Investors use this as a guide when they walk the show floor. New in 2012 in cooperation with Expo host New Hope is a 'Shark Tank' format public event where four entrepreneurs compete in front of an investor/expert panel.

To be considered for inclusion, please fill in the profile below. Companies filling in the profile will also get a list of investors in attendance.

NCN will also make this list of exhibiting companies seeking capital or partners available to its members or Cornerstone Investors (see NCN website for a list).

Please complete profile submissions by September 10, 2012. Any questions can be directed to Mike Dovbish at 415-202-5254 or mdovbish@nutritioncapital.com. By submitting this application you are authorizing Nutrition Capital Network to share this information with NCN-member investors.

Question Title

1. Please indicate all items for which you want to be considered:

Shark Tank Pitch Slam: September 19th (only 4 will be selected by committee)

NCN list of companies seeking capital or partners (all will be included for investor attendees at NCN at Expo East 2012 session on September 20th and NCN member investors)

Presenter at NCN XI in San Francisco on October 16th

Presenter and NCN Ingredient & Technology Investor Meeting in Las Vegas on November 6th

Presenter at NCN XII on East Coast in April 2013

Question Title

2. Contact Information: (Required.)

Name: *

Company: *

Address:

Address 2:

City/Town: *

State: *

ZIP/Postal Code: *

Booth Number: *

Email Address: *

Phone Number: *

NCN at ExpoEast/Shark Tank/Company Listing Application/September 2012

1. Application to be listed as a company seeking investment at ExpoEast

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1. Please indicate all items for which you want to be considered:

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2. Contact Information: (Required.)

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3. 10-15 word company snapshot (e.g. $2 million natural hair care and cosmetics company selling in natural foods stores and on line.) (Required.)

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4. Product descriptions, brand names, patents, trademarks or exclusives, business model. (What makes your company unique.) (Required.)

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5. Reasons for raising capital, amount sought and intended use of capital; or desired outcome in partnership. (Required.)

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6. Approximate 2011 sales and estimated 2012 sales. (Required.)

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* 1. Please indicate all items for which you want to be considered:

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* 2. Contact Information: (Required.)

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* 3. 10-15 word company snapshot (e.g. $2 million natural hair care and cosmetics company selling in natural foods stores and on line.) (Required.)

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* 4. Product descriptions, brand names, patents, trademarks or exclusives, business model. (What makes your company unique.) (Required.)

Question Title

* 5. Reasons for raising capital, amount sought and intended use of capital; or desired outcome in partnership. (Required.)

Question Title

* 6. Approximate 2011 sales and estimated 2012 sales. (Required.)

1. Please indicate all items for which you want to be considered:

2. Contact Information: (Required.)

3. 10-15 word company snapshot (e.g. $2 million natural hair care and cosmetics company selling in natural foods stores and on line.) (Required.)

4. Product descriptions, brand names, patents, trademarks or exclusives, business model. (What makes your company unique.) (Required.)

5. Reasons for raising capital, amount sought and intended use of capital; or desired outcome in partnership. (Required.)

6. Approximate 2011 sales and estimated 2012 sales. (Required.)