Name *

First Name

Last Name

Phone *

(###)

###

####

Business Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Years in Business *

0-1

2-5

6-10

I plan to participate

In Person

Virtually (Directions and online link provided in confirmation message. LIMITED opportunities for virtual participation.)

Is the product/service you will pitch for InnovateHER currently in the market? *

Yes

No

Eligibility + Media Release

I agree that I meet all SBA InnovateHER Challenge criteria as outline on the www.sba.gov/InnovateHER and https://www.challenge.gov/challenge/2017-innovateher-innovating-for-women-business-challenge. I agree to the use of my image, likeness in still, visual or audio form may be used by the SBA and local host as a result of my registration and participation.

Yes

No