Launch Pad Membership Application

Complete the form to be considered for a member of the Center for Enterpreneurship & Innovation Launch Pad.

Make sure you have read all rules of conduct and information on the Membership page

Application Information
Name Name * First Last
Email *
Phone Phone * - ### - ### ####
Title:
Affiliation to UNG:
Management Team
Management Team (please list all team members and their titles):
Company
Business Information
Startup Stage:
Business structure:
Year started
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Web Site
Would you like to receive additional information about our Entrepreneurship offerings via email?
Check if yes:

Would you like to receive additional information about our Entrepreneurship offerings via email?
Check if yes: Yes
By clicking submit, you acknowledge that you have read and accept the rules of conduct for the Launch Pad.

In addition, you agree that to the best of your knowledge all statements made and information provided as a part of this application are true and accurate.

You also affirm that you understand as part of the application screening process that owners, as well as all references provided, may be investigated.

Furthermore, you affirm that you understand that this application is subject to review and Open Records as is the policy of the State of Georgia and applying in no way guarantees the applicant’s admittance into the University of North Georgia Launch Pad.

Launch Pad Membership Application

Launch Pad Membership Application

Application Information

Management Team

Business Information