1:1 Sessions will be held with representatives from Merck on October 4th. LSWI will reach out to you by September 26 if you are selected for a meeting.

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* 1. First Name

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* 2. Last Name

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* 3. Professional Title

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* 4. Phone

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* 5. Email Address

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* 6. Company name

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* 7. Street address

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* 8. City

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* 9. State

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* 10. Website

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* 11. Year incorporation/ formation

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* 12. Number of employees

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* 13. Subsector (select one)

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* 14. Technology Classification (select all that apply)

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* 15. Area of focus (select all that apply)

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* 16. Management team and Board (200 word max)

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* 17. Target / Underlying Biology / MOA / Modality

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* 18. Disease area(s) / Disease(s) targeted

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* 19. Description of your technology (200 word max)

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* 20. Development Stage

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* 21. Key partnership objectives (200 word max)

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* 22. Current partnerships and/or alliances (200 word max)

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* 23. Key next steps in development

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* 24. Are you generating revenue?

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* 25. Recent milestones and next steps (200 word max)

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* 26. Status of Intellectual Property

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* 27. Ownership

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* 28. Capital raised to date and funding history

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* 29. Amount of capital sought, and milestones to be achieved on that capital (200 word max)

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