Community Membership Application Name * First Name Last Name Pronouns * Email * What is your company name? (If you have one) * What is your company's website? (if you have one) http:// How many years has your business been operating? * How much revenue did your business make last year? * Under $50,000 $50,000-$100,000 $100,000-$250,000 Over $250,000 Please select your registration and jurisdiction that applies: * We're registered in Canada We're not registered, but in Canada We're registered, but not in Canada We're not registered, and not in Canada Have you spoken to potential customers that would use your products/services? * Yes No Have you raised funds for your business before? * Yes No What are you looking our of your Impact Zero membership? * Give us your elevator pitch! What problem do you solve? * Which membership are you applying for? * Keep in mind the social membership meets weekly on Tuesdays at 10-11am EST Growth Membership ($250/month) Social Membership ($50/month) I'm not sure I consent to the collection, use, and disclosure of my personal information on this form for the purpose of assessing my application. * Yes, I accept After clicking Apply Now, be sure to schedule your interview! You'll be directed to the scheduling page automatically.
