Super Connect - Startup Expression of Interest
If you are a startup or scale-up interested in attend or pitching in one of our Super Connect Series Days around the UK, please fill in the below form. A member of our team will be in touch shortly after to inform you if your expression of interest to attend or pitch has been approved.
Company
*
Name
*
First Name
Last Name
Position
*
Email
*
example@example.com
Where are you based?
*
LinkedIn Profile
*
How would you categorise your company?
*
Pre-seed tech startup (funding for early milestones, no revenue; Friends & family, early-stage angels, startup accelerators; £25k - £500k)
Seed tech startup (early product/market fit, early revenue; Angels, early-stage VCs, Accelerators; £150k - £10m)
Tech Scale up (Series A - Product market fit, solid revenue; VCs & Super Angels, £2m - £100m)
Tech Scale up (Series B, C+ - full scale expansion; VCs, Late stage VCs, Private Equity, Hedge Funds; £20m - £800m)
SME ( > 250 employees, non-tech)
None of the above
Business Models of Interest (‘What is your business model?’)
*
B2B
B2C
B2B2C
B2G
Other
Innovation Category (‘what type(s) of innovation does your product cover’)
*
AI,
Internet of Things IoT,
MedTech,
HealthTech,
FinTech,
Blockchain,
HRTech,
Enterprise,
RetailTech,
PropTech,
Smart Cities,
5G,
Cyber Security,
AR,
VR,
EdTech,
CleanTech,
AgriTech,
BioTech,
GreenTech,
InsurTech,
TravelTech,
FoodTech,
AutoTech,
AdTech,
WearableTech,
RegTech,
LegalTech,
FemTech
Other
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Outcomes of Interest (‘what types of funding are you interested in?’)
Angel Investment
VC Investment
Impact Investment
Grants
Loans
Other (if selected, must specify in new field to be revealed)
Not interested in funding
Please upload your latest Pitch Deck
Browse Files
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of
Ticket Size (‘what is the minimum to maximum ticket size you are looking for?’)
£0 - £25k
£25k-£50k
£51k - £150k
£151k - £250k
£251k - £500k
£501k - £1m
£1m - £5m
Other
Minimum Revenue per month (‘What is the minimum revenue (if any) that you are currently turning over? If you are pre-revenue, please put zero) - Currency field / optional field
*
What are your Company Challenges
*
Legal Challenge
Advisory Board Challenge
Design Challenge
Development Challenge
Quality Assurance Testing Challenge
Recruitment Challenge
HR Assessment Challenge
Communication Challenge
Marketing Challenge
International Payments Challenge
Investment Challenge (crowd-funding)
Investment Challenge (angels)
Investment Challenge
Grant Funding Challenge
Grant Writing Challenge
Loan Challenge
R & D Tax Credit Claim Challenge
Other
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GENERAL EXPRESSION OF INTEREST FIELDS
Register for Our Events: What events would you like to register for? By selecting the below cities we will expect that you will attend on the day and only select them if you know from now that you can join as we go to a lot of effort to prepare for your arrival. (If a date is not mentioned below, selecting the box will be a general pre-registration and we will email you once we have the date for you to inform us by email if you can attend)
*
24th September 2020 - Edinburgh (AI, Smart Cities, MedTech)
October 2020 - Basingstoke (AI, AR/VR, 5G)
18th November 2020 - Birmingham (AI, Cyber Security)
25th February 2021 - Bristol (AI, HRTech, RecruitmentTech)
March 2021 - Dublin (AI, FinTech, Cyber Security)
March 2021 - Belfast (AI, MedTech, Cyber Security)
Who you be interested in pitching at one of our super connect events?
YES (Your application will be assessed by a steering committee who then decides who will be invited to pitch)
NO
In the Future
Super Connect Me:
*
I would like to receive up to 5 free pre-matched super connections upon arrival and after the event by email to those that match my registered interests and I consent for these connections to be made (Free Service)
I would like to receive 6-30 pre-matched super connections before, during and after the event to those registered for the event, and the wider Super Connect Series network across 14 cities - and I consent for these connections to be made (Paid Service)
I do not want to be super connected, I’m happy to attend and do my own networking on the day
Every Super Connect Series event has our famous ‘Wall of Faces’ loved by many of our attendees where those that opt-in below have their Linkedin photo added. This helps you to find other attendees that may match your interests and attract people to find you at the event to start conversations quickly see example here: www.superconnectseries.com/faceswall
*
I consent for my Linkedin photo to be added to the ‘Wall of Faces’ at the event and consent for it to appear at the event (Free Service)
I do not wish for my photo to be added to be the Wall of Faces
Working with Empact Fields ‘Are you interested in working with Empact Ventures?
Ad-hoc pre-qualified introductions from time-to-time to companies and/or funders that match your registered interests above? (No Cost)
Join our Super Connect PEAK Programme to get both support to get ready to scale and qualified introductions to the right potential clients, partners and/or funders across the UK and Ireland (Paid Service)
Joining our Super Connect FLEX Programme to get qualified introductions only to the right potential clients, partners and/or funders across the UK and Ireland (Paid Service)
Co-designing or sponsoring a future Super Connect Series event in an existing city or one of your choice (Paid Service)
No, I am not interested in the above right now
I am interested in working with Empact In the Future
1 month
3 months
6 months
12 months
2 years
No, I’m not interested at all
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GDPR PREFERENCES
In line with GDPR, Empact Ventures Ltd would like to ensure we contact you in the right way and it would help us if you could inform us if you’d like u to reach out in future about getting involved in the below:
Please select at least one method preferred communication
*
Please Select
Empact Super Connecting Opportunities (e.g. reactive ad-hoc relevant introductions to useful individuals, deal flow, organisations and/or opportunities)
Super Connect Series Newsletter (e.g. latest deal flow, opportunities, resources, useful contacts etc.)
Super Connect Series Events
Empact Support Options (e.g. proactive paid support)
None of the Above
If you would like to request a copy of the Hays Tech Start Up Report 2019,/2020 produced in conjunction with Empact Ventures please select below (please note, by requesting a copy of the report, you agree that your personal data will be shared with Hays)
*
YES
NO
Would you like to receive recruitment related tips and be informed about other services and events. If you agree, your personal data will be shared with Hays to provide you with this information, please see here the privacy policy - http://bit.ly/haysppy
*
YES
NO
In line with GDPR, do you want to connect with the below partner organisations and by selecting the options you agree that you consent for us to share your email address with them to contact you:
*
GEN UK (TBC) - newsletter
Young Enterprise - newsletter, volunteer or partner
Microsoft for Startups - newsletter
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