Personal details First name:  * Surname:  * Company name:  * Position:  * Contact details Address:  * Suburb:  * Postcode:  * Phone: ()  * Fax: () Mobile: Email: Web site: http:// Your portfolio 1) Which of the following groups best describes you? Venture Capitalist   Angel Investor   Fund Manager   Broker Group / personal net worth: 2) Please select the type of industry you would be interested in investing in? Biotechnology Business Services Communications Computer Hardware Computer Services Customer Products Distribution Diversified Electronics Energy Financial Services Healthcare Internet Manufacturing Media Medical Devices Medical Services Pharmaceuticals Real Estate Retail & Wholesale Semiconductor Software Technology/Telecommunications Other: 3) Typical investment size? Below $100,000 Over $100,000 Over $200,000 Over $300,000 Over $400,000 Over $500,000 Over $750,000 Over $1 million Over $2 million Over $3 million   4) Would you be interested in becoming a Premium Investor Club Member? Yes   No
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