Pre-Incubation Application Form

First Name*

Last Name*

Company Name*

Job Title*

City*

Country*

Is the company?*

Service Based
Product Based
Other

If you selected other, what is the company based in?

Primary Industry*

Tech
BioMed
Energy
BioTech
Big Data
AI
Mixed Reality
Advanced Manufacturing
Other

If you selected other, what is the company's primary industry?

Secondary Industry (If Applicable)

Years in operation

Total number of company employees

Total revenue

Is the company family owned?

Please give a short summary of the company.*

What is your primary interest in this program?*

Meet potential customers
Understand regulatory environment
Form strategic partnerships
Raising Capital
Other

If another reason, please describe below:

If raising capital, how much has been raised to date?

List Management Team (Name, Title, Quick Intro)

Email*

Phone (Include Country Code)*

Any additional documentation & resumes to be considered

Drop files here or

Accepted file types: jpg, pdf, doc, png, mp4, Max. file size: 32 MB, Max. files: 10.

How did you hear about this program?

By submitting this form, you are consenting to receive marketing emails from: Business Incubator Association of New York State, PO Box 95 , Albany, NY, 12201, US, http://www.bianys.com. You can revoke your consent to receive emails at any time by using the SafeUnsubscribe^® link, found at the bottom of every email. Emails are serviced by Constant Contact.

CAPTCHA

Soft Landing Application