TiECON Southeast 2012 Awards - Up-and-Coming Entrepreneur

"Up-and-Coming Entrepreneur"- Nomination Form

- Nominee activity/event must have occurred between April 1, 2011 and February 29, 2012.
- The deadline for all nominations is April 10, 2012
- Attendance at the conference is encouraged. The awards portion of the TiECON Southeast 2012 Conference will be held from 3:00 p.m. - 5:00 p.m. at the Renaissance Atlanta Waverly Hotel.
- All information will remain confidential to the judging team. If you have any questions, please
contact awards@tie-atlanta.org.

Nominee information:

Nominee information: Name:
Company:
Title:
Email Address:
Phone Number:

Nominee's assistant (if applicable)

Nominee's assistant (if applicable) Name:
Email Address:
Phone Number:

Nominator information (if different than the nominee)

Nominator information (if different than the nominee) Name:
Company:
Phone Number:
E-mail Address:

Your affiliation with the Nominee (if any):

Describe your company? (<less than 150 words)

What is your three to five year vision?

Do you have any seed, angel or other types of financial investment? If yes, please describe. (actual financial numbers are not required)

Please share your significant milestones? (please use bullets)

Describe your largest areas of growth? (less than 150 words)

Who are some of your most important customers?

What is your biggest challange? (less than 150 words)

List any additional information you would like for the judges to know? (Up to 200 words)

Describe your roles and responsibilities within the company? (<less than 150 words)

How have you contributed to the community? (Up to 150 words)

I CERTIFY THAT ALL INFORMATION IS CORRECT

I CERTIFY THAT ALL INFORMATION IS CORRECT Yes