CannX, The Third International Medical Cannabis Conference, 14 -16 October 2018

Start-up Application Form

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* 1. ORGANIZATION BACKGROUND

Company Name

Year Established

Full Address

Website

No of Employees

No of R&D Personnel

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* 2. PROJECT TITLE

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* 3. THE PROBLEM

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* 4. THE SOLUTION

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* 5. INNOVATION & ADVANTAGES

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* 6. IP STATUS

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* 7. MARKET POTENTIAL

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* 8. COMPANY CURRENT STATUS

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* 9. TEAM MEMBERS

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* 10. ROADMAP - MILESTONES TO COMMERCIALLIZATION

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* 11. THE RESOURCES NEEDED

Investment required for next round:

Additional investments in future rounds until product commerciallization

Amount invested in the company to-date

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* 12. COMPANY VALUATION FOR NEXT ROUND

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* 13. COMPANY'S SHAREHOLDERS

SHAREHOLDER NAME (indicate %)

SHAREHOLDER NAME (indicate %)

SHAREHOLDER NAME (indicate %)

SHAREHOLDER NAME (indicate %)

SHAREHOLDER NAME (indicate %)

SHAREHOLDER NAME (indicate %)

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* 14. CONTACT PERSON DATA

Last Name

First Name

Function

Title

E-mail

Mobile

Direct Telephone

Fax