Member Interest Form

1
First Name* This field is required.
2
Last Name* This field is required.
3
LinkedIn Profile* This field is required.
4
Are you an accredited Investor (income of $200k/yr as individual, $300k/yr as couple for past 2 years OR $1M in assets not including primary residence)* This field is required.To read more about being accredited, please visit https://www.sec.gov/resources-small-businesses/capital-raising-building-blocks/accredited-investors to review the requirements.
Yes
No
5
Unfortunately, we can only accept accredited investors into the fund. If you are unsure about your accreditation status or still want to learn more about the fund, you can continue onwards to submit the form.
6
Email* This field is required.
example@example.com
7
Phone Number
Please enter a valid phone number.
8
City* This field is required.
9
State* This field is required.
Please Select
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
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District of Columbia
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Hawaii
Idaho
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Louisiana
Maine
Maryland
Massachusetts
Michigan
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Mississippi
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Montana
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Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
USA-Other
Non-USA
10
Country* This field is required.
Please Select
Please Select
United States
Canada
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Cape Verde
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo (Republic of the)
Congo (Democratic Republic of the)
Costa Rica
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor (Timor-Leste)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Fiji
Finland
France
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
North Korea
North Macedonia
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
São Tomé and Príncipe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Sweden
Switzerland
Syria
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
11
Have you done angel investing before?* This field is required.
Yes
No
No, but I chose angel investments for other accredited investors
12
In what areas do you have expertise?* This field is required.
Accessibility
Accounting
Advertising
Aerospace
Agriculture
Architecture
Automotive
Banking
Biotechnology
Broadcasting
Chemicals
Compute Science/Programming
Construction
Consulting
Consumer Goods
Customer Service
Data Analysis
Defense
DEI
Education
Electronics
Energy
Entertainment
Environmental
Fashion
Finance
Food & Beverage
Government
Healthcare
Hospitality
Human Resources
Information Technology
Insurance
Journalism
Legal
Logistics
Manufacturing
Marketing
Media
Mining
Non-Profit
Operations Management
Pharmaceuticals
Project Management
Publishing
Real Estate
Retail
Sales
Science
Software
Sports
Telecommunications
Tourism
Transportation
Utilities
Venture Capital
Waste Management
Wholesale
Other
13
Would you be interested in participating in diligence?* This field is required.
Yes
Not sure, I would need more information
No
14
Would you be interested in holding a board position within our portfolio companies?* This field is required.
Yes, and I have held board positions before
Yes, but I have not held a board position before
No, but I have been on boards before
No
15
Is there anyone you think would be interested in joining Adaptation Ventures?Please provide name and contact information or let us know who they are if you will make the intro
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Large
Normal
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Ok
Ok
16
Would you like to share anything else with us?
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Ok
Ok
17
Please verify that you are human* This field is required.
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