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Membership Stipend

Please answer each question as completely as possible so that we have all the relevant information with which to make a decision about your qualifications for a membership stipend!

The Basics

First Name

Last Name

Company Name

Your Role (in startup)

Your Venture

Startup description (keep it short!)

Company URL

I'm working on this venture

Company stage

Funding

I'm interested in the following programs *

Start Smart Class
Mentor Program
Launch Smart Clinic
Other

I'd like to help offset my stipend by volunteering at in-person events (when they're back...) *

Yes
No
Maybe

Timeout Warning

Membership Stipend

The Basics

Your Venture