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Member Investor Application

Please provide as much information as you can about your investment preferences, qualifications, and participation plans, to speed up the approval process. Fields marked in bold with an asterisk (*) are required.

Applicant Information
Cover Letter:
First Name: *  
Last Name: *
Invests As::    
Example:"My Dream Investment, LLC"
LinkedIn URL Profile:    
Example: http://www.linkedin.com/yournamehere
 Blog:  
 Website:  
 Referred By:  
 
Contact:
Email: *  
Work Phone: *  
Cell Phone:  
Fax:  
Address Street 1: *
Address Street 2: *
City: *
Zip Code: * (5 digits)
State: *
 
Biography:* Please share a brief professional biography
You can include your investing and work experience,
hobbies, or anything else that you like.

Investment Group Involvement
 
Please describe any other investment groups
that you are involved with:

Group Interests
Participation:

How are you interested in getting involved with Advising Angels?
Deal Sourcing
  Screening Deals
  Due Diligence
  Business Mentor
  Leading Deals
  Represent at Events
  Serve as Board Member
  Social Activities
  Other:
Investment Interests     
My Investment Interests Include:
   Biotechnology
   Business Products & Services
   Clean Technology
   Computers & Peripherals
   Consumer Products & Services
   Education
   Electronics / Instrumentation
   Financial Services
   Food / Drink
   Gaming
   Healthcare Services
   Industrial / Energy
   Internet / Web Services
   IT Services
   Lifestyle
   Marketing / Advertising
   Media & Entertainment
   Medical Devices & Equipment
   Mobile
   Nanotechnology
   Networking & Equipment
   Retailing / Distribution
   Semiconductors
   Software
   Sports
   Telecommunications
   Travel
   Other 
 Accredited Investor: *  Are You an Accredited Investor? 
Capital:   
How much do you expect to invest per year?
Under $25,000
$25,000-$50,000
$50,000-$100,000
$100,000-$250,000
$250,000-$500,000
$500,000-$1,000,000
$1,000,000+
   
if applicable, please tell us what type of service provider you are:
 

Experience: 
 
What previous or current positions have you held?
 Board Member
   Chief Executive Officer
   Chief Financial Officer
   Chief Information Officer
   Chief Technology Officer
   Accounting Partner
   Legal Partner
   VC Partner
   Other Partner
   President & Chief Operating Officer
   Vice President of Engineering
   Vice President of Manufacturing
   Vice President of Marketing
   Vice President of Operations
   Vice President of Sales
   Other 
 
Functional Experience:
 
My functional experience includes:
   Board Membership
   Engineering & Manufacturing Quality
   Financial Accounting
   International
   Legal
   Logistics
   Marketing & Advertising
   Negotiations
   Operations
   Organizational Development & Recruiting
   Product
   Public Relations & Communications
   Sales
   Science & Technology
   Strategic Planning
   Other 

Industry Experience
 
In which industries do you have experience?
   Biotechnology
   Business Products & Services
   Clean Technology
   Computers & Peripherals
   Consumer Products & Services
   Education
   Electronics / Instrumentation
   Financial Services
   Food / Drink
   Gaming
   Healthcare Services
   Industrial / Energy
   Internet / Web Services
   IT Services
   Lifestyle
   Marketing / Advertising
   Media & Entertainment
   Medical Devices & Equipment
   Mobile
   Nanotechnology
   Networking & Equipment
   Retailing / Distribution
   Semiconductors
   Software
   Sports
   Telecommunications
   Travel
   Other 
 
Ethical Standards 
 
 
Please answer the following questions on ethical standards:
 Yes or No? *  
Have you been or are you currently the subject of,
a defendant in, or respondent in any investigation,
civil litigation, arbitration, or other action or proceeding
in which your professional conduct, in either
a direct or supervisory capacity, was at issue?

 
Please include a written statement providing all details:

 Yes or No?: *  
Have you been or are you currently the subject of a written
complaint regarding your professional conduct in either a direct
or supervisory capacity?  Have you been or are you currently
permanently or temporarily prevented from: (i) acting as a person
required under any law or regulation (i.e. investment advisor,
broker, dealer, etc.); (ii) acting as an affiliated person or employee
of any entity required to be registered under any law or regulation
(i.e. investment company, bank, etc.); or (iii) trading on any
securities or contract market?

   
Please include a written statement providing all details:

 Yes or No?: *  
Have you been or are you currently found to have aided, abetted,
counseled, commanded, induced, or procured the violation
by any person or entity of any securities or commodities
regulated law or regulation or any rule promulgated there under?

   
Please include a written statement providing all details:

 Yes or No?: *  
Have you been or are you currently convicted of (i) any felony or
other crime punishable by more than one year in prison, or
(ii) a misdemeanor involving moral turpitude (lying, cheating,
stealing, or other dishonest conduct) or any substantially
equivalent crime in any court of law?

   
Please include a written statement providing all details:


 Security Code: *