Personal Email

City & Country of Residence

Nationality of Passport

(If you have not yet sent Sarah@maxnx.com a copy of your passport or national ID to be issued to the SCC and state of Delaware please do so ASAP!)

Current Department

Current Title

SECTION 2: EXPERIENCE AND INTERESTS

EXPLAIN WHY NOT IF NO AND HOW IF YES

HAVE YOU EVER RAISED FUNDS FOR A START UP OR VENTURE FUND>

Have you ever Built your own start up?

If no - write "N/A", If yes to either of the above 2 questions, please share details on the fund or startup, amount raised, and timeline

What industry type of startups do you prefer to work with?

Are you open to hosting a mastermind circle for MoonshotNX?

Do you have a newsletter, blog, or podcast you’d like us to be aware of?

SECTION 3: INTERNAL FEEDBACK

Are you interested in a higher management position within Maxnx

Are there any changes you would like to see implemented internally?

Anything else you would like to discuss here?