Presenting Company Registration

Home About Us Sponsors Schedule Member List Registration Videos Disclaimer Contact Us

Presenting Company Registration

Information and secure registration are online for prospective presenting companies and attendees to pre-register to attend at a discount up to two weeks before each scheduled conference. Seating is limited.

Cancellation Policy: If received in writing 20 days in advance, SWIA will refund 75% of the total fees. The presenting company shall be liable for 100% of the total fees during the 20 day period.

Presenter's Form

Company Name:

Address:

Street Address:

City: State: Zip:

Website:

Email:

Company Phone Number: Mobile Number:

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

Select one
Public Exchange or Private Company

NYSE

AMX

NASDAQ

OTCBB

Pink Sheets

Foreign Exchanges

Private Company

Symbol

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

Presenting Company Fees: (Due upon application to reserve your presentation place)

American Express

Visa

Mastercard

Discover

Corporate Check

Registration Fee $2,500.00:

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

Cardholder name:
(as it appears on the Credit Card):

Credit Card Number

Expiration Date (MM/YY):

Credit Card Billing Street Address:

Credit Card Billing Zip Code:

3 Digit Security Code:

Electronic Signature

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

Presenter #1: Title:

Presenter #2: Title:

Company Objective:

Company Exposure

Public Offering (type and stage)

Private Placement

PIPE

Other

If Other, please explain

List the Date on the Offering / PPM / PIPE:

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

Offering/Financing Size and Structure
(Please answer TBA, where applicable.)

Offering Amount $

Number of Units Available:

Price Per Unit

Type of Stock & Reg./Rule:

Number of Warrants Available

Price of Warrants Available:

Additional Structure Detailed Information

Recent Bid Price:

Proposed $ offer Price, If IPO:

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

Market Information

52 Week Range:

Shares Out: Market Cap:

Estimated Float

Average 3-Month Volume: 1 year Target:

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

Encapsulate Company Overview (Products, markets, uniqueness, objective, and competition)

Investment Attraction/New Development/Projection Statements/ Why should an investor buy your stock or offering?:

Selective Financial Highlights:

Actual

Forecasted

Month of Year-end: Fiscal Year Ending Revenue:

Fiscal Year Ending Pre-Tax Income Fiscal Yr End Net Income

Fiscal Year Ending Earnings / Share:

Fiscal Year Ending Weighted Average Share

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentations Aids You Will Provide

Overnight CD PowerPoint or DVD

Email PowerPoint

My company would like to provide a gift(s) to give away to draw more attention at the podium to my presentation.

Yes

I would like someone to contact me about purchasing some type of promotional item to hand out during the presentation.

Yes

Cancellation Policy:

If recieved in writing 20 days in advance, SWIA will refund 75% of the total fees. The presenting company shall be liable for 100% of the total fees during the 20 day period.

Management reserves the right to refuse companies.

Southwest Investment Association, Inc. | 11302 Raveneaux Dr. | Frisco, TX 75034 | 214.712.2154