Shareholder-form | Impact Shakers

To become a cooperator,
please complete the form below.

Before signing up, read the internal regulations and the information note.

First name

Last name

Your full address for the proof of payment (nr, street, city, country, zip)

Company name and legal form

Amount I would like to invest (multiples of 250 euro only)

Phone

Date of birth

Name of legal representative

Position(s) you are interested in:

Emerging Angel (get access to the Emerging Impact Angel Programme)

Investment Committee

Expert

Just a member for now

I have read the internal regulations and the information note.

Thanks for submitting!