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-> Membership Application Confirmation
Do not use this form to renew an existing NBIA membership. To renew your NBIA membership, click
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.
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Your Email
*
:
Organization Name
*
:
If joining as an individual, please put your name in the top line and your college/organization (if applicable) in the second line
Org's Generic Email:
Description of Organization
*
:
An Operating Incubation Program
Developing an Incubation Program
Economic Dev Org (no incubator)
Former Incubator (now closed)
Government Agency (no incubator)
Individual Member (fac, stdt or ret)
National/Regional Incubation Assoc.
Sponsor for Incubator(s)
State Incubator Association
University/College (no incubator)
VC or investment based
Vendor/Service Provider/Consultant
Since your organization currently operates a business incubation program, there is some data we would very much like you to provide NBIA. Please note: this information is NOT Mandatory in order to complete the application for membership in NBIA. We merely request that you provide information as you are able. We would prefer estimates over blank fields.
If you provide information on your incubation program, it will be used to produce industry statistics in the aggregate – your individual organization’s information will not be released. The resulting industry statistics will provide NBIA current information as we advocate for the business incubation industry, and will be available to the membership for your needs as well.
Each year, as you renew your membership on line, these questions will pre-populate with the data we currently have for your organization, so over time we hope to have the most current information available for your program.
Thank you for taking the time to provide this important data on your business incubation program!
*
= required field
Questions about your incubation program
Date incubator began accepting clients (MM/DD/YYYY):
Incubator Type:
-- no selection --
Manufacturing
Mixed Use (serves a variety of company types)
Service/Professional
Technology
Other
Demographic/population focus of incubator:
-- no selection --
No special focus
Foreign/nondomestic Entrepreneurs
Student Entrepreneurs
Low-income Entrepreneurs
Micro-entrepreneurs
African-Americans
Hispanic-Americans
Native Americans/Indigenous Peoples
Women
Youth
Other
Incubator's geographic area :
Hold the control key to select more than one applicable item.
Rural
Suburban
Urban
Incubator's primary sponsor:
Hold the control key to select more than one applicable item.
University or four-year college
Community/technical or two-year college
City/county/state/national government
Hybrid (accountable to a consortium with no single controlling agency)
For profit organization
Nonprofit economic development organization
Other
No sponsor
Incubator's tax status:
-- no selection --
For profit
Nonprofit
Industry sectors supported by incubator:
Hold the control key to select more than one applicable item.
Advanced Materials (ceramics, films, polymers, etc.)
Aerospace
Arts
Bioscience - agriculture / plant
Bioscience - Life Sciences
Computer Hardware
Computer Software
Construction
Defense/homeland security
Electronics/Microelectronics
Energy
Environmental
Fashion
Healthcare Services
Healthcare technology
Information Technology
Internet
Kitchen/food
Manufacturing
Media
Medical Devices
Nanotechnology
Nonprofit Organizations
Retail
Services/professional
Technology
Telecommunications
Tourism
Wireless Technology (RFID, Wi-Fi, etc.)
Wood/forestry technology
Current number of resident clients:
Current number of affiliate/virtual clients:
Number of client companies graduating in the past 12 months :
Number of graduate client companies in the last 5 years:
Number of graduate companies still in business (even if acquired/merged):
Incubator provides pre-incubation services:
-- no selection --
Yes
No
Incubator provides post-incubation services:
-- no selection --
Yes
No
Number of months (average) resident clients receive services before gradation (graduates only):
Number of months (average) virtual clients received services before gradation (graduates only):
Incubator's total leasable square footage (as of close of last FY):
On average, percentage of leasable space actually leased to clients in last FY:
Total full-time jobs produced by resident clients (as of close of last FY):
Total full-time jobs produced by affiliate/virtual clients (as of close of last FY):
Total part-time jobs produced by resident clients (as of close of last FY):
Total part-time jobs produced by affiliate/virtual clients (as of close of last FY):
Total full-time jobs produced (incl owners) by graduate firms in last 5 years (at close of last FY) :
Total part-time jobs produced (incl. owners) by graduate firms in last 5 years (at close of last FY):
Total combined grant revenue (in US$) of all client companies (res. or virtual) for last complete FY:
Total combined sales revenue (in US$) of all client companies (res. or virtual) for last complete FY:
Total combined revenue (in US$) of all client companies (res. or virtual) for last complete FY:
Street Address
*
:
Address Line 2:
City
*
/ State / Zip
*
:
-- no selection --
Alabama
Alaska
Alberta
American Samoa
Arizona
Arkansas
British Columbia
California
Colorado
Connecticut
Delaware
District of Columbia
Fed St of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Manitoba
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
N Mariana Islands
Nebraska
Nevada
New Brunswick
New Hampshire
New Jersey
New Mexico
New York
Newfoundland
North Carolina
North Dakota
Northwest Territory
Not Available
Nova Scotia
Ohio
Oklahoma
Ontario
Oregon
Palau Island
Pennsylvania
Prince Edward Island
Puerto Rico
Quebec
Quebec City
Rhode Island
Saskatchewan
South Carolina
South Dakota
Tennessee
Texas
US Virgin Islands
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Yukon Territory
Country:
United States
Algeria
Antilles
Argentina
Armenia
Australia
Austria
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Bermuda
Bolivia
Bosnia
Botswana
Brazil
Brunei
Bulgaria
Canada
Cape Verde
Chile
China
Colombia
Commonwealth of Dominica
Congo
Costa Rica
Croatia
Cyprus
Czech Republic
Denmark
Dominican Republic
Ecuador
Egypt
El Salvador
Estonia
Ethiopia
Falkland Islands
Fiji
Finland
France
Georgia
Germany
Ghana
Gibraltar
Greece
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kuwait
Kyrgyzstan
Lagos
Latvia
Lebanon
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malaysia
Malta
Mauritania
Mauritius
Mexico
Moldova
Mongolia
Morocco
Mozambique
Nepal
Netherlands
Nevis
New Zealand
Nigeria
Norway
Oman
Pakistan
Palestine
Panama
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saudi Arabia
Senegal
Serbia
Serbia & Montenegro
Singapore
Slovakia
Slovenia
South Africa
South Korea
Spain
Sri Lanka
St. Vincent and the Grenadines
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Trinidad & Tobago
Tunisia
Turkey
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
USA
Uzbekistan
Venezuela
Vietnam
Yugoslavia
Zimbabwe
Phone Number:
Fax Number:
Org Web Address:
Please sign me up for the following
membership category
*
:
$99 Emeritus Retired (1 member included, restrictions apply)
$99 Student (1 member included, restrictions apply)
$199 Individual Faculty (1 member included, restrictions apply)
$295 Basic (1 member included)
$425 Select (1 to 3 Members) (up to 3 members included)
$450 Select (4 Members) (up to 4 members included)
$475 Select (5 Members) (up to 5 members included)
$550 Consultant/Vendor (up to 2 members included)
$795 Premium (1 to 12 Members) (up to 12 members included)
$820 Premium (13 Members) (up to 13 members included)
$845 Premium (14 Members) (up to 14 members included)
$1,100 Corporate (up to 3 members included)
How did you hear about NBIA?
-- no selection --
Internet Search
Event or training
Information received by post/mail
Information received by e-mail
Business contact or NBIA member
Other (please specify)
Please provide details (i.e., site, event or person):
This page was last updated on August 07, 2008.
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