Pitch For Good: Healthcare Edition Submission Form

Pitch For Good: Healthcare Edition Submission Form

***Applications close at Friday, November 13th at 11:59p CT***
Please submit a 1-minute pitch video of your idea or company. We will use this information to select the entrepreneurs to participate, so please keep in mind before you submit.
- Limited to one entry per person.
- Individuals who have received a financial grant for Pitch For Good in the past are not eligible.
Name *

First Name Last Name
Idea or Company Name *
Email *
example@example.com
Phone Number

Area Code Phone Number
Upload your 1-Minute Pitch Video

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What stage are you? *

Launch - Companies with Revenue of $0-$25k Up and Running - Companies with Revenue of $25k-$1m
What would you do with the $$ if you won? *
Where did you hear about this opportunity? *
ie. LaunchTN, my friend Haley Combs, EC Newsletter, etc
As a reminder, this opportunity is reserved for either founders based in TN, or EC program Participants/alumni. Please select one *

My business is located in Tennessee I am in, or have been in, an EC Program
By submitting this application I certify that the information is true and correct. I also acknowledge and agree to the following:
- My name and image, company logo, company name, and submission video may be used for marketing and publicity by the EC.
- For any grants or awards received, payment of taxes is the sole responsibility of my company or the representing individual.
- If selected to receive an award or grant I will provide a report outlining the use of funds and results and will periodically provide investment, revenue, and manpower data upon request. (All data is held confidential to the EC and its grantors.)
- Pitch for Good sponsors will receive my email address in order to follow up regarding additional opportunities.
Signature required: *

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