Form | 150 StartUps

Full Name*

Cell Phone Number*

Company Email Address*

Gender**

Racial/ethnic group do you identify with**

Company Name*

Head Office Location*

Title*

LinkedIn Profile**

How did you first hear about this program?*

Number of full-time sales people currently employed*

Enter the number, not the word.

Secondary Contact Name*

Who could take your place if there was a session you can't make?

Untitled

What is the title of the person who would take your place if there was a session you can't make?

Company website address*

Industry**

Business Type*

Choose all that apply

Business to Consumer (B2C)

Business to Business (B2B)

Business to Government (B2G)

Company revenue in the last 12 months*

$0 - $49,999

$50,000 - $99,999

$100,000 - $249,999

$250,000+

Projected company revenue in the next 12 months*

$50,000 - $99,999

$100,000 - $249,999

$250,000 - $499,999

$500,000 +

Number of full-time employees*

Enter the number, not the word.

Number of part-time employees*

Enter the number, not the word.

How many employees do sales as part of their job?*

Enter the number, not the word.

Entrepreneurship support programs you have already completed or are currently part of*

List any entrepreneurship programs, cohorts, incubators or accelerators you have already completed and when you completed them or are currently part of and, if applicable, the expected completion date. E.g. TECTERRA, VMSA, GrowthX, Lean Stack, Digital Traction, Creative Destruction Labs (CDL), Platform, The Accelerator, Junction, 150 Startups, etc.

Why you?*

Explain why you believe you are a good fit for the program and why you should be selected to participate.

Personal Participation*

Do you personally commit to fully participate in the program and build a working sales playbook for your organization during the program?

Yes

Participation Conditions*

I agree that by not fully participating in, or being removed from, the program as promised above, that I may be asked to pay the $1,500 registration fee for the program.

I agree to the conditions of participation

Comments

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