STIRR Membership Application Form
To be considered for a STIRR membership, please fill out the following application form.
Name:
*
(first, middle, last name)
Company / Organization / School
*
Corporate Web Site
Personal Blog, LinkedIn Profile or other online biography
*
Email:
*
Title
*
Phone #:
*
*
Please include area code
I am interested in attending STIRR events primarily in my role as:
*
Please select...
Change Agent
Aspiring Entrepreneur
Founding Entrepreneur
Angel Investor
Venture Capitalist
Press/Media
How do you like to participate in ventures that you invest in?
Describe your current and past investments and their success or vital lessons.
Other memberships & leadership roles we should know about?
Tell us about your coverage of technology. What audience do you reach? (geography, # people, types of people)
Tell us about your start-up – what’s your vision and how will it change the world?
What breakthrough contributions did you make?
What are the 2 most courageous things you’ve done to build/grow the company?
Share how you’ve funded the start-up so far.
Other memberships & leadership roles we should know about?
Have you attended BarCamp?
Yes
No
Describe your current and past investments and their success or vital lessons.
Other memberships & leadership roles we should know about?
What startup ventures have you been part of & what employee # were you when you joined?
What breakthrough contributions did you make?
What founders have you worked with?
Tell us about your start-up or Venture – what’s your vision and how will it change the world?
Who are your co-founders and mentors?
Describe your past ventures and exits.
Anything else that STIRR Canada should know about you?
If you were introduced to or referred to STIRR by a member, please share their name(s).
Need assistance with this form?