NCN at Expo West: Company Listing Application/March 2013

1. Application to be listed as a company raising capital at Expo West

Each year Nutrition Capital Network leads an educational session at Natural Products Expo West for investors with an interest in nutrition & health & wellness companies. As part of this orientation, NCN distributes a lead list of Expo exhibitors 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.

To be considered for inclusion on this year's list, please fill in the profile below. Applicants will receive a list of investors in attendance.

NCN will also make its list of exhibiting companies seeking capital available to NCN members and Cornerstone Investors (See NCN website for Cornerstone Investors and Sponsors.)

Please complete profile submissions by March 1, 2013. For questions contact Mike Dovbish at 415-202-5254 or mdovbish@nutritioncapital.com. By submitting this application you are authorizing Nutrition Capital Network to share your information with investors.

Question Title

* 1. Contact Information:

Name: *

Company: *

Address:

Address 2:

City/Town: *

State: *

ZIP/Postal Code: *

Booth Number: *

Email Address: *

NCN at Expo West: Company Listing Application/March 2013

1. Application to be listed as a company raising capital at Expo West

Question Title

* 1. Contact Information:

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

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

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* 4. Reasons for raising capital, amount sought and intended use of capital; or desired outcome in partnership.

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* 5. Approximate 2012 sales and estimated 2013 sales.