Presenting Company Registration
Capital Conference
7a.m. to 2p.m.
 

PRESENTING COMPANY:                                                                                                                                                     
Company Name: 
(Company name and address must match exactly the way your Company is listed with the
SEC, incorporated or organized)
Address:  
City: State: Zip:  
Country:  Website:  email:  
Toll Free #:             Other:    Fax:  
Public Exchange It Trades On:
   Symbol:   Public Offering: Private Company:   
Sector:   
    Industry:
SCIA  MEMBER SPONSOR:
 Name of Your Sponsor:  Sponsor’s Phone:  

 

List Main Management First:
1. Main Executive Name: Title:
    Main Executive’s Cell : Email:
2. Second Representive Name: Title:

    Second Representative’s Cell: Email:

 

PRESENTING COMPANY FEES:(Due upon application to reserve your presentation date)

All Fields Must Be Completed  

INAUGURAL BASIC FEE: $7500.00

ADDITIONAL COMPANY MANAGEMENT/REPRESENTIIVE’S: Add $70.00 per person

 3. Name: Title:              
 4. Name: Title:

$600.00 to host the cocktail reception hour before the luncheon. SCIA will promote you immediately and exclusively. This is inexpensive and a good opportunity for extra promotion of your Company before the luncheon.
TOTAL FEE DUE UPON APPLICATION TO RESERVE TIME
SLOT: $

 

Electronic Signature: Must be Clicked to Process Registration and all Funds:

Corporate Overnight Check to SCIA is Preferred to: SCIA, 1278 Glenneyre Street #19, Laguna Beach, CA 92651

Company Check Overnight    Check #   


 

AMEX     VISA    MC   Discover Excepted. Call 949-922-3003 to Process Payment

Cardholder

 

 

Presenting Company Profile

 

COMPANY OBJECTIVE
Stock Exposure: Public Offering (type and stage):
Private Placement:  PIPE: (Private Investment in  a Public Entity, stock offered with registration rights)
Other
List the date on the Offering/PPM/PIPE: Bridge Loan: Other:                 
 

OFFERING/FINANCING SIZE AND STRUCTURE: (Please answer TBA, where applicable)
Offering Amount $No. of Units Available@ $per unit
Type of Stock & Reg./Rule with No. of Warrants Available
@ $  Additional Structure Detailed Information: 
                         

MARKET SUPPORT INFORMATION (Please Indicate "Proposed Stock Symbol, Offer Price and Exchange" for IPO):  
 

NYSENasdaq : NMSAMEXNasdaq : Small Cap OTC : BBNQB : Pink  
Other Exchange: 
Stock Symbol: Recent Bid: (Proposed Offer Price, If IPO)$
52Week Range:Shares Out:Market Cap:
Est. Float          Ave 3 m. Vol.: 1yr. Target Est:

1. ENCAPSULATE COMPANY OVERVIEW (Products, markets, uniqueness, objectives, and competition);
2. INVESTMENT ATTRACTION /
NEW DEVELOPMENTS / PROJECTION STATEMENTS / Why should an investor buy your stock or offering?
(Points on How Investing in Your Company May be Timely):
200 Word Max
 

SELECTIVE FINANCIAL HIGHLIGHTS  actual     forecasted

Month of Your Yr. End:
 

 Fiscal Years Ending:

Months ending:

 

Revenue:

Pre-Tax Income:       

Net Income:

Earnings/Share:

Weighted Ave. Shares:

 

PRESENTATION AIDS YOU WILL PROVIDE:  
Overnight CD PowerPoint or
DVD   *emailed PowerPoint

At least 3 days prior to conference / No changes at conference

FINAL copy ONLY with F I L E labeled with your Company Name as registered with SCIA to: scia@sciaconference.com
   
 
(Our wireless remote mouse pointed at the screen will let you control your presentation.)
My Company would like to provide  as a givaway(s) at the podium to gain more attention to my company and presentation.


We are interested hostingor joint hostingthe before lunch cocktail reception.

Name of person filling out this form:
Title: Phone: Ext.: Email:

 

Cancellation Policy: If received in writing 20 days in advance, SCIA will refund 50% of the total fees.  The presenting company shall be liable for 100% of the total fees during the 20 day period.  

 

Management reserves the right to refuse or defer companies.

               
 

We look forward to having you join us. Call when we may be of service.