CiRX Customer Research (July 2010)

1. Personal details and role(s)

Please answer all subsequent sections of the survey that apply to you (and skip those that do not apply); the survey has the following sections

* Company management / founders [Section 2]
* Non-executive director [Section 3]
* Angel / private investor [Section 4]
* Institutional investor [Section 5]
* Legal Advisor [Section 6]

and please complete the final section specific to CiRX [Section 7].

*
1. In what way are you involved with (one or more) private companies? (check all that apply)

In what way are you involved with (one or more) private companies? (check all that apply) Company management / founder

Non-executive director

Angel / private investor

Institutional investor

Professional advisor (legal, accounting, etc.)

2. Please tell us more about yourself. (fill in only what you are comfortable disclosing, this information will not be shared outside of nauiokas park llp and CiRX)

Please tell us more about yourself. (fill in only what you are comfortable disclosing, this information will not be shared outside of nauiokas park llp and CiRX) Name
Country of residence
Email address
Phone
Skype ID
Twitter ID

CiRX Customer Research (July 2010)

1. Personal details and role(s)

*1. In what way are you involved with (one or more) private companies? (check all that apply)

2. Please tell us more about yourself. (fill in only what you are comfortable disclosing, this information will not be shared outside of nauiokas park llp and CiRX)

*
1. In what way are you involved with (one or more) private companies? (check all that apply)