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: *
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
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: *