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Division:

Black (undergraduate)
Gold (graduate)

Team Name (10 letters or less)

Description:

Must be fewer than 100 words including spaces and punctuation.

Team Leader Information: (Must Be A Purdue Student)

First Name:

Last Name:

Address Line 1:

Address Line 2:

City:

State:

Zip Code:

e-Mail Address:

Phone Number:

Class:

Freshman
Sophomore
Junior
Senior
MS
PhD
Other

Are you enrolled in the Certificate Program:

Yes
No

Purdue Program/Major

Second Team Member: First Name:

Last Name:

e-Mail:

Class:

Freshman
Sophomore
Junior
Senior
MS
PhD
Other

Are you enrolled in the Certificate Program:

Yes
No

Institutional Affiliation/Purdue Program or Department:

Third Team Member: First Name:

Last Name:

e-Mail:

Class:

Freshman
Sophomore
Junior
Senior
MS
PhD
Other

Are you enrolled in the Certificate Program:

Yes
No

Institutional Affiliation/Purdue Program or Department:

Fourth Team Member: First Name:

Last Name:

e-Mail:

Class:

Freshman
Sophomore
Junior
Senior
MS
PhD
Other

Are you enrolled in the Certificate Program:

Yes
No

Institutional Affiliation/Purdue Program or Department:

Fifth Team Member: First Name:

Last Name:

e-Mail:

Class:

Freshman
Sophomore
Junior
Senior
MS
PhD
Other

Are you enrolled in the Certificate Program:

Yes
No

Institutional Affiliation/Purdue Program or Department:

Sixth Team Member: First Name:

Last Name:

e-Mail:

Class:

Freshman
Sophomore
Junior
Senior
MS
PhD
Other

Are you enrolled in the Certificate Program:

Yes
No

Institutional Affiliation/Purdue Program or Department:

Seventh Team Member: First Name:

Last Name:

e-Mail:

Class:

Freshman
Sophomore
Junior
Senior
MS
PhD
Other

Are you enrolled in the Certificate Program:

Yes
No

Institutional Affiliation/Purdue Program or Department:

How did you hear about the Burton Morgan Business Plan Competition? (100 words or less)

I need auxiliary aids/services due to disabilities. Please contact me.

Yes

*Participants acknowledge that they either have clear ownership of the presented technology or have completed a license agreement with the institution that owns the property. NOTE: Purdue's Office of Technology Commercialization will confirm this.)

Yes

*Disclaimer: It is the responsibility of the participants to protect the intellectual property of their entry. The participant agrees to hold harmless Purdue University and its affiliates and representatives as well as the competition's sponsors, judges, and attendees for disclosures of the participants' intellectual property.

Yes

*I have read, agree to and meet the eligibility rules of the Burton Morgan Competition.

Yes