ActivateNM Membership Application Form

Thank you for joining the Activate New Mexico community. Please answer the questions below so we can get a better idea of the resources you might need. The estimated amount of time to complete is 10 mins.
CONTACT INFORMATION

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* 1. First Name

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* 2. Last Name

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* 3. E-mail Address

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* 4. Mailing Address

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* 5. Cell Phone Number (use numbers only)

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* 6. Do you have a LinkedIn Profile? (If Yes, please insert a copy of LinkedIn Profile link)

STARTUP INFORMATION

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* 7. Business Name

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* 8. Date Business was started:

Date

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* 9. Describe your business in one (just one) sentence?

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* 10. What is your business' legal structure?

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* 11. Business website:

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* 12. Number of team members or employees:

YOUR MARKET AND SOLUTION

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* 13. To the best of your ability, describe the problem your product is solving, who pays you (aka who is your customer), and why your product is innovative. (No more than 5 sentences)

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* 14. How much revenue has your business generated to date?

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* 15. What is your plan in terms of capital/funding/revenue for this business?

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* 16. How many hours a week do you work ON your business?

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* 17. Are you looking for startup coaching and accountability?

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* 18. What value or assistance do you hope to receive by joining the ActivateNM startup community?

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* 19. Anything else you would like the ActivateNM community to know?

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