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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: *

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.

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.