Forme Investisseur Adresse courriel Contact Details Full Name * Company Name Position Street Address * City * Postal Code * Phone Number * Website Email Address * Investor Details Please indicate your current affiliation by ticking the appropriate box. * Private Investor Corporate Investor Other Please indicate the amount you would consider investing in any one company. * $0 to $9,999 $10,000 to $24,999 $25,000 to $49,999 $50,000 to $99,999 $100,000 or more Please indicate the total amount you are seeking to invest per year. * $0 to $9,999 $10,000 to $24,999 $25,000 to $49,999 $50,000 to $99,999 $100,000 or more Please indicate whether you are willing to invest in the same company alongside other investors (apart from co-investors you may organize yourself). * Yes No Please indicate whether you have previously invested in companies as an angel investor. * Yes No Please describe the opportunity and business or market sectors that would be of particular interest to you. * Please indicate the types of business or industry categories that are of no interest to you. * Are you interested in active involvement with companies in which you invest? * Yes No If yes, please indicate areas of expertise that you would be able to contribute. Please tick all that apply. * Marketing Production Finance Legal Technical Management Please indicate the type of management involvement you would like to have with a company in which you invest. * Non-Executive Full Time Executive Part Time Executive No Involvement Any additional information you would like us to know?