Great Valley Techology Alliance

Registration Form

* Name of Team Leader

* Phone Number

Work Number (if applicable)

Company Name (if applicable)

Fax Number

Cell Number

* E-Mail

* Address

* City

* State

* Zip Code

Names of Team Members

* NEPACU School Name

Faculty Advisor

Name of Business Plan

* To be pre-qualified for the competition, please describe the technology component of your business plan