First Name

Last Name

Email

Phone number

Type of Membership
Individual Membership - 300 EURCorporate Membership - 2500 EUR

Personal code or Date of birth

Link to your Linkedin profile

Residence address

What is the main source of your income?
Salary / Self-employmentDividend incomeSuccessful exit of business / investmentRent and other incomeInheritanceNone of the above

Please indicate the amount you are willing to invest per year
0 - 10 000 EUR10 001 - 50 000 EUR50 001 - 100 000 EURmore than 100 000 EUR

What are the three things you most seek in LitBAN?
Pitch eventsTraining sessionsDeal-flowSyndicationNetworkingNone of the above

What companies are you most interested in?
Early stage technology driven businessesSMEs seeking financingReal estate projectsNone of the above

Have you been approved as a private investor by Koinvesticinis Fondas (www.koinvest.lt)?
YesNo

Would you agree to be promoted as an investor and a member of LitBAN on our website www.litban.org and other social channels?
YesNo

To submit your application, please type the characters you see in the picture