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* 1. Email address:

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* 2. Name of Start Up:

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* 3. Industry:

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* 4. Please identify the stage of start up:

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* 5. Which area are you lacking bench strength?

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* 6. What challenge do you hope to solve with the consulting hours?

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* 7. If there is a need to learn more about the challenge, please share email contact of the best person to reach out to:

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