BB Participation Form

Participation Form For Bull and Bear Club Events

Thank you for your interest in presenting and participating at a Bull and Bear luncheon, dinner or cocktail reception. To present, please fill out the information below.

For other questions regarding presenting, or this form, please phone Ross DiMaggio at 609-360-0584

* Please check the boxes of the Emerging Private Company event(s) that you wish to present and participate at:

There are no events scheduled at this time.

* Company Name

* Payment Information:

Check will be mailed (Please send to Friedland Investment Events LLC, 600 S Cherry St, Suite 530, Denver, CO 80246)

Wire transfer (For wire transfer instructions please phone 1-303-785-8968)

American Express (Please go to www.friedlandinvestmentevents.com/pdfs/cc.pdf for Credit Card Authorization Form)

Please provide information on the person from your company who will be giving your company's presentation:

* First Name

* Last Name

Title

* Business Phone

Mobile Phone

* Email Address

Please provide us with the names of additional representatives of your firm who will be attending the event(s):

Name

Please provide us with the person from your firm who should receive event specifics:

* First Name

* Last Name

* Phone Number

* Email Address

Please provide us with your billing information/billing contact:

* First Name

* Last Name

* Street Address

Address Line 2

* City

* State

* Zip Code

* Phone Number

* Email Address

Please provide us with the person who you would like included in the event program as your company contact:

* First Name

* Last Name

Title

* Phone Number

* Email Address

Please upload your company's PowerPoint.

Please upload a Word or PDF company description:

Please upload your company's logo.

* Please contact us regarding your inviting our contacts, associates or key shareholders to the event(s):

Yes

No

Comments or Questions:

Terms and Conditions: Due to the limited number of presenting companies that our format allows, payment is due promptly to ensure your participation. Full credit will be provided towards participation at other events if canceled 30 days prior to the scheduled event. 50% credit will be provided towards participation at other events if canceled within 30 days of the scheduled events. We do not provide cash or credit card refunds. All amounts are in US dollars, and if paid by check, must be paid with a check drawn on a US bank. Payments made from outside the USA must be made by wire transfer or credit card. This Agreement to Present/Participation Agreement is governed by the laws of the State of Colorado, and subject to sole jurisdiction in the State of Colorado.

Participating companies are urged to seek their own legal counsel regarding the applicability of Federal and state securities regulations that may affect their particpation at the Bull and Bear Club's Emerging Private Company events, their handouts and presentation.

* Indicates Response Required