Membership Form

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Primary Contact

First Name

Last Name

Title

Phone

Are you the CEO or Founder?

YesNo

CEO or Founder name

CEO or Founder email

CEO or Founder phone number

Demographics

Which of the following do you / a company founder /a majority owner identify as? (Please choose all that apply?)

First generation college studentImmigrantLGBTQ+Person with disability (visible or invisible)PhysicianUnited States VeteranNone of the aboveI prefer not to answer this question

Which of the following do you / a company founder /a majority owner identify as? (please choose all that apply)

FemaleMaleNon-binaryOtherI prefer not to answer this question

Which of the following do you / a company founder /a majority owner identify as? (please choose all that apply)

African-American/BlackAmerican Indian/Alaskan NativeEast AsianHispanic/LatinxMiddle EasternPacific IslanderSouth AsianSoutheast AsianWhiteI prefer not to answer this question

Company Information

Company

Website

Company headquarters

Detailed company description, including product overview and value proposition

Phase of development

When was the company founded?

Team

Number of full-time employees

Please input a whole number, no text or special characters

Number of contractors

Please input a whole number, no text or special characters

Market Opportunity

Describe the healthcare problem your company solves

Who is or will be purchasing your product?

Please specify

How large is the market for your product?

Technology

Technology type

Please specify

Business

Have you raised funding?

Funding type

Friends and familyAngel investorsVenture capitalPrivate equityOther

Cash invested to-date

Please input a number with no decimals

Please upload your business plan, executive summary or pitch

How did you hear about MATTER?

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Contact Information