Company Name *

Nominating ACA Member Group *

First Name *

Last Name *

Email *

Phone

ACA Member Group Website *

Brief Description of Investor Group: *

Why are you nominating this company and how does it embody the spirit of the LV Award? *

Company Industry (choose one): *

Enter required value Life Sciences (Pharma, Med devices, HealthCare IT, Digital or Mobile Health, etc.) Technology, Services, & Consumer: (Hardware & Software, Social Media, Web 2.0., Fintech, AgTech, etc.)

How long have you supported the company? *

Do you currently have a Board seat? *

Enter required value Yes No

How much has your group invested over what time period? *

Identify other angel groups or VC's invested in this company. *

Read Description and Affirm: *

I affirm that if this nominated company is selected as a 2025 Luis Villalobos Award category winner, I or an angel champion I nominate will be attending the 2025 ACA Summit as company ambassador.

I Affirm