Put Your Group Name Here: Membership Application

This document is a membership application for an angel investment group. It requests information such as name, contact details, investment experience, interests, expertise, and accredited investor status. Applicants are asked to provide details about their previous investments, deals, and involvement with other groups. They must also disclose any regulatory or legal issues in their professional conduct. The application gathers information to evaluate applicants and their potential role and contributions to the group.

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Put Your Group Name Here: Membership Application

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Digitaladda India

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Put Your Group Name Here

Membership Application
Please include a cover letter with a brief professional biography, at the
top of this document.
Name:
Email address:
Address:
Phone:
Invests as:
LinkedIn profile URL:
Website/Blog:
Referred by:
How much money do you typically invest per year?
How many deals have you been a part of?
Are you involved with any other angel/investment groups?
Please indicate which groups and briefly describe your
involvement.
Interests:
Leave all that apply, delete the rest
Deal Sourcing
Screening Deals
Business Mentor
Leading Deals
Represent at Events
Serve as Board Member
Social Activities
Other (Explain below)

Investment Interests
Indicate industry interests, ex. Biotechnology or Clean Technology
Industry Expertise
Which industries do you have experience in?
What previous positions have you held?
Ex. CEO, Board Member, Engineer
How much do you expect to invest each year?
Are you a service provider?
Legal Services, Accounting
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?
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?
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?
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?