Wufoo

WaVE Membership Application

Please fill out this form to be considered for membership in WaVE. Required fields are marked with a red*.

NOTE: All information will remain confidential and will not be disclosed or sold to any party outside of the WaVE membership.

Name * First Last
Name of WaVE member who referred you First Last
Current or Most Recent Web Venture *

Please see WaVE Membership Guidelines for definition of a "web venture"
Title at Current or Most Recent Web Venture - Select all that apply *
CEO Founder/Co-Founder Key Executive Investor Board Member/Advisor None of the above
URL of Current or Most Recent Web Venture *
Address of Current or Most Recent Web Venture
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Main Phone of Current or Most Recent Web Venture ### - ### - ####
Cell Phone or Best Number To Use * ### - ### - ####
Best Email Address To Use *
Company Description of Current or Most Recent Web Venture (in 50 words or less, briefly describe what you business does/will do)
*

Use 50 words or less
Company Stage *

Choose the stage that best applies to your current web venture
Actual or Planned Launch Date MM / DD / YYYY
Key Milestones Achieved To Date at Current or Most Recent Web Venture

Provide additional details about key milestones achieved to date for your web ventures. (Ex: sales, patents/trademarks, key employee hires, strategic partnerships, etc.)
How much of your current or planned revenues come from site advertising (includes banner ads) or from site usage fees collected from registered users *

Required - Please note that the answer to this question AND the question below should not add up to more than 100%.
How much of your revenue comes from or will come from offline services such as market research, analysis or consulting services? * *

Required - Please note that the answer to this question AND the question above should not add up to more than 100%.
Other relevant experience for consideration of WaVE - Please include name(s) and date(s) of previous web ventures you were involved in
Title at Previous Web Venture - Select all that apply *
CEO Founder/Co-Founder Key Executive Investor Board Member/Advisor None of the above
Do Not Fill This Out