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Full Name/Organisation Name
ID/Passport/ Registration Number
Cell/Tel Number
Email
Investor Type
Natural Person
Investment Firm
For-Profit
Non-Profit
Other
Other
Country
Region
Erongo
Hardap
//Kharas
Kavango East
Kavango West
Khomas
Kunene
Ohangwena
Omaheke
Omusati
Oshana
Oshikoto
Otjozondjupa
Zambezi
Not Applicable
Physical Address
Membership Application Type
New Member
Renewing
Have you ever been an angel investor?
Yes
No
In which industries have you invested or would you be interested in? (check all that apply)
Health care
Environment
E-commerce
Agriculture
Media
Biotechnology
Industrial
Hardware
Manufacturing
Investments
Business/Financial
Engineering
Software
Telecommunications
Energy
Consumer Products
In which industry(s) do you have professional experience? (check all that apply)
Health care
Environment
E-commerce
Agriculture
Media
Biotechnology
Industrial
Hardware
Manufacturing
Investments
Business/Financial
Engineering
Software
Telecommunications
Energy
Consumer Products
What business skills/expertise do you have? (check all that apply)
Board member
Legal
Employee benefits
Investments
Public relations
Operations
Financial services
Sales
Infrastructure
Marketing
Strategic planning
Insurance
Accounting
Senior management
Business plan development
Research & development
Have you ever been a company founder or officer? (check all that apply)
Founder
CEO
CFO
COO
CIO
Other
Other
As an Angel, what is the range of your expected investments in a year? (only one)
N$25,000 - N$50,000
N$50,000 - N$100,000
N$100,000 - N$250,000
N$250,000 - N$500,000
N$500,000 - N$1 mill
N$ 1mill +
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Yes, I accept the terms and conditions
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