BizStarts Milwaukee Mentoring Service Acknowlegement and Release Form

BizStarts Milwaukee Mentoring Service
Acknowledgement and Release Form

* Required

First Name: *

Last Name: *

Organization: *

Address: *

Address:

City: *

State: *

Zip Code: *

Home Telephone: *

Work Telephone: *

Fax:

Cellular:

Email Address: *

Referred by:

Currently employed:

Yes No if yes, by:

Venture Name:

Venture industry or field:

Major obstacles(s)

you are currently facing:

Acknowledgements and Release From Liability BizStarts Milwaukee Mentors (BSMM)

I acknowledge that I have read, understand and will abide by the BizStarts Milwaukee Rules for Participating Entrepreneurs, copies of which have been given to me.

I also acknowledge that BizStarts mentors are uncompensated and can provide only educational support and that they cannot make business decisions for BizStarts entrepreneurs, and I hereby release from liability, and waive all claims that I, my heirs, successors and assigns may have against any BizStarts mentor or consultant for any actual or claimed errors or other acts or omissions.

I further acknowledge that BizStarts Milwaukee, Inc.does not control or direct its mentors in connection with services provided to entrepreneurs or their ventures, and I hereby release from liability, and waive all claims that I, my heirs, successors and assigns may have against BizStarts Milwaukee, Inc.and its directors and officers for any actual or claimed errors or other acts or omissions of the BizStarts mentors.

Finally, I acknowledge that the activities of BizStarts Milwaukee Mentors are conducted largely by volunteers on a best-effort basis who are fully independent of and are not directed by BizStarts Milwaukee, Inc. its , its employees, or its officers (collectively, BizStarts Milwaukee), and I hereby release from liability and waive all claims against BizStarts Milwaukee that I, my heirs, successors and assigns may have for any actual or claimed errors or other acts,or omissions, including,but not limited to negligent acts of BizStarts Milwaukee or its directors, officers, or mentors or anyone else connected with BizStarts Milwaukee Mentors.

Signature: ___________________________________________________

Name: ______________________________________________________

Date: _________________________

A copy of this form has been emailed to you. Please sign & date the form and return it to the address listed bleow with your Resume and Executive Summary.

Thank you for Mentoring new entrepreneurs.

Submit three documents:	By Mail to:
Your resume	BizStarts Milwaukee, Inc.
Executive summary	10437 Innovation Drive
This form	Suite 317
	Milwaukee, WI 53226