A100 Membership Application

Apply to join the A100

Are you a seasoned tech founder, executive or board director who has been through the full lifecycle of a startup and are looking to share that experience?

Apply to join the A100 and offer advice and connections to help inspire, grow and support the next generation of tech and innovation leaders.

Charter Membership: $1000 annual dues + $500 one-time initiation fee

The A100 is committed to diversity, equity, inclusion, and belonging. We have made it a priority to do our part to help eliminate discrimination and promote opportunity equity with regards to age, disability, gender identity or gender expression, race, ethnicity, religion or belief, sex and sexual orientation, marriage or civil partnership, or pregnancy or maternity within our membership and throughout the broader tech community.

Application Form – General Membership

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Your Profile

Name*

Email*

Phone*

Current Company*

Current Title*

Tell us about your experience.

Have you “been there, done that” and built or operated a successful company as a founder or a C-Level executive? A100 members require the skills, experience, expertise and network to help Alberta startups increase their chances of success.

Do you meet this criteria?*

Yes, I have scaled a technology-focused business that has used its proprietary technology as a source of competitive advantage

Yes, I am committed to participating in the A100’s mission to inspire the next generation of tech and innovation leaders. This means engaging in A100 programs and our communities in an inclusive, respectful and professional manner

Applicants must have experienced at least two of the three startup milestones listed below.

Yes, I have founded or operated a technology company with significant market cap reflective of industry

Yes, I have generated annual revenues of at least $5 Million (CAD)

Yes, I have successfully exited a technology company

Please share a short bio.*

A100 aspirations

Given the criteria above, outline why you would like to join the A100?*

Do you have any experience mentoring or advising technology startups?*

Yes

Which startups?*

Anything else about you that we should know?

Who in the A100 supports your nomination?

Please share information for three active A100 members who support your candidacy (current Members can be viewed at www.thea100.org/members)

A100 Member #1*

First Last

A100 Member #2*

First Last

A100 Member #3*

First Last

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Name

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