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* 1. What is your name?

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* 2. What is your email?

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* 3. What program are you interested in participating in?

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* 4. What is your start-up or idea name? (it's ok if you don't have one yet)

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* 5. What type of product are you looking to launch? (please select all that apply)

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* 6. How many team members (excluding yourself) do you have?

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* 7. Where are you located?

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* 8. What is your background in? (degrees, previous experience etc.)

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* 9. Which of the following best describes you?

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* 10. When are you planning on launching your product?

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* 11. What stage of your project are you in?

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* 12. What industry does your product or service apply best to?

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* 13. Where are you at in your funding process?

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* 14. Are you currently part of a start-up lab, incubator or similar program?  If so, please specify.

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* 15. How did you hear about Ecco Design?

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* 16. Anything else you'd like to share?

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