VentureSouth Standard New Member Application Form

Thank you for your interest in joining VentureSouth! Please complete the form below to submit your membership application. We will review and follow up with you to process your membership. Thank you again and we look forward to welcoming you to VentureSouth.

MEMBERSHIP QUALIFICATIONS

Membership in VentureSouth is offered by invitation only to interested accredited investors at the discretion of the Managing Directors of VentureSouth.

All new Members must complete this Membership Application including self-certification of accreditation.

Membership may be terminated or revoked at the discretion and determination of the Managing Directors if they determine that a Member has breached any terms of membership.

AS A CONDITION OF MEMBERSHIP, YOU MUST AGREE TO THE FOLLOWING:

I will abide by the terms and rules of the Membership Code of Conduct included below.

I understand that VentureSouth is not a venture fund, investment bank, broker/dealer, investment clearinghouse, investment portal, crowdfunding platform, or any other form of an investment advisor or otherwise, and is not registered with the Securities and Exchange Commission or any state securities commission. VentureSouth does not provide advice, recommendation, or any other indication of appropriateness or inappropriateness for a particular investment.

I must conduct my own analysis and due diligence to determine the appropriateness of any investment I make in any company to which I am introduced through VentureSouth. I recognize and agree that neither VentureSouth nor its representatives or agents are responsible or liable for any investment decision I make as a result of being a member of VentureSouth. The choice to use and the manner of utilization of information and knowledge gained through VentureSouth is my individual and personal choice.

I understand that VentureSouth meetings are not an offer to sell or solicitation to buy any security by VentureSouth or any other entity.

MEMBERSHIP CODE OF CONDUCT

I will conduct myself in a professional manner at all times.
I will respect the privacy of other members and not provide any member's name to any third party without permission, and I will keep membership information confidential.

I understand that the information provided to VentureSouth by candidate companies is confidential and I will not share the information outside the group without permission. I also understand that disclosing or using such information for any purpose other than investing is prohibited.

I understand and recognize that VentureSouth meetings and communications are focused on investment pursuits and will not solicit another member for business.

I will disclose to the group any relationship or potential conflict of interest I have or may have with a presenting company, including any personal gain I may receive from the company or from information provided by the company.

I will not pre-empt or circumvent the VentureSouth investment process once a company has entered the VentureSouth pipeline.

EMAIL AND INFORMATION SHARING

I understand that VentureSouth communicates to its members and investors in portfolio companies through various platforms including email, and I hereby provide authorization to use my email address for such purposes.

VentureSouth members become members of the Angel Capital Association, the leading trade organization for angel groups in North America. The ACA provides angel groups and their members with invaluable resources including best practice sharing, investor education, public policy advocacy, and connections to leading angels across the country. By joining VentureSouth, you automatically become a member of the Angel Capital Association, and we encourage you to sign up for member-only access on their website at www.angelcapitalassociation.org

First Name*

Last Name*

Formal Name*

Tax Classification*

Entity Name (if membership to be held in name of entity)

NameEntity Type (LLC, C-corp, etc.)If LLC, number of members

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Will you be sharing your membership with another individual, such as a spouse or business partner?*

YesNo

Joint Member's Information*

Who will be the Primary Member?*

MEMBERSHIP DUES*

I agree to pay the $2,500 annual membership dues in a lump sum by check or ACHI agree to pay the annual membership dues via credit card draft on a monthly basis at a rate of $215 for a minimum of 12 months ($2,580 total). After 12 months, my membership will renew automatically at the same monthly rate until such time as I inform VentureSouth of the termination of my membership by email.

How did you hear about VentureSouth?*

If a Member referred you, please note their first and last name so we can show our appreciation!

What is your primary motivation for joining VentureSouth?

Please enter your LinkedIn profile:

DISCLAIMER

VentureSouth is not a venture fund, investment bank, broker dealer, investment clearing-house, investment portal, crowdfunding platform, or investment advisor. It is a forum in which individuals may be introduced to companies and educated on aspects of investment and business. VentureSouth is not registered with the Securities and Exchange Commission or any state securities commission. Each member is responsible for his or her own investment decisions, and VentureSouth is not recommending any particular company for investment. All investments in entrepreneurial companies involve a high degree of risk, and investors should be able to bear the risk of complete financial loss. The choice to use and manner of utilization of information and knowledge gained through VentureSouth is each member’s individual and personal choice. No guidance shall be given, nor shall any person affiliated with VentureSouth be responsible, for an individual member’s use of the information, investment decision, or the results of any investment. VentureSouth makes no representations or warranties regarding these companies. Investors are under no obligation to invest in any company, and they must conduct their own due diligence and make their own independent decision on any investment they make.

RELEASE AND INDEMNIFICATION

I acknowledge and agree that all investment decisions I make as a member of VentureSouth are entirely my own decisions and are based entirely on my own due diligence investigations and therefore I hereby release VentureSouth and its managers, members, officers, employees, advisors, attorneys, agents, contractors and subcontractors, and the heirs, successors and assigns of all such persons (each a “VentureSouth Party”), from any and all liability for any losses, costs, expenses, damages, obligations, liabilities, causes of action, fines, penalties and the like, including without limitation reasonable attorneys fees and costs (collectively “Losses”), that I, any of my affiliates or any heir, successor or assign of me or any of my affiliates, may incur in connection in any way with my participation or involvement with VentureSouth or with any investment I make or decline or fail to make in any entity, except to the extent such Losses result from the gross negligence or willful misconduct of VentureSouth. I further hereby agree to defend, indemnify and hold harmless each VentureSouth Party from and against any Losses incurred by me, any of my affiliates, any heir successor or assign of me or any of my affiliates, or any VentureSouth Party in connection in any way with my participation or involvement with VentureSouth or with any investment I make or decline or fail to make in any entity, except to the extent such Losses result from the gross negligence or willful misconduct of VentureSouth.

ACCREDITATION CERTIFICATION*

(i) if an individual, the undersigned had individual income (exclusive of any income attributable to a spouse) of more than $200,000 in each of the two most recent years (or joint income with a spouse in excess of $300,000 in each of the two most recent years), and the undersigned reasonably expects to reach the same minimum income level in the current year; or(ii) if an individual, the undersigned has an individual net worth or combined net worth with a spouse, in excess of $1,000,000, exclusive of the value of the primary residence; or(iii) if an individual, the undersigned holds in good standing a Series 7, Series 65 or Series 82 license; or(iv) if an entity, all of the undersigned’s equity owners are “accredited investors” as described in items (i) or (ii) or (iii).

The undersigned member agrees to notify the Managing Directors of VentureSouth promptly if the undersigned member in the future no longer qualifies as an accredited investor. The undersigned member also agrees that any payment of membership dues in future years explicitly reaffirms the accreditation certification made herein.*

YesNo

Member Signature*

Powered by Jotform Sign Clear

Today's Date*

Date

Would you like to opt in for local meeting text reminders? (you may opt out anytime):

YesNo

First & Last

Accreditation Text

Thank you again for your interest in joining VentureSouth. We will follow up with you shortly and we look forward to welcoming you as a member!