Entrepreneurs Form

Please fill in your in your information below.

Company Name

Company Location

Company Website

Company Contact

Contact Email

Key Management

One line company description

In what general area of healthcare/medicine does your company reside?

What is the the primary problem your company aims to solve?

Are you currently fundraising?

Yes No

If yes, how much funding has your company previously raised?

How much funding are you looking to raise in this round?

At what valuation are you raising this round?

How is this round structured and under what terms?

Link to pitch deck

Link to one pager

Link to video or other supporting material

How did your hear about GHIN?

Would you like to join our GHIN Network?