MENTORS
* field mandatory
NAME *:  
FIRST NAME :*  
ORGANIZATION: *  
EMAIL *  
COUNTRY * 
PHONE 
COMPENSATION
How much would be your hourly rate per week ?*
30 - 50 $US / hour
50 - 70 $US / hour
70 - 90 $US / hour
90 - 110 $US / hour
110 - 130 $US / hour
Superior to 130 $US / hour
Other :
If needed, how much would be your Equity stake acquisition rate ?*
none
0.5 %
1 %
1.5 %
Other :
How many hours are you ready to allocate for your mentorship per week?
Less than 5 hours
from 5 to 10 hours
from 10 to 15 hours
15 hours and More
On-site working rate?
0 %
from 0% to 10%
from 10% to 30%
from 30% to 50%
from 50% to 75%
from 75% to 100%
SUPPORT
Company target: *
Pre-seed 
Seed
Serie A
Serie B
Serie C + / Internal - External Growth
Mature / MBO / MBI / LBO 
Mature / Distressed and turnaround Funding
Support zone area :
North America
Europa
Asia
Middle-East
South America
Oceania
Africa
Support field: *
Strategic Advice
Developping network
Tech expertise
Operational support
Other :
CONCLUSION:
ENCLOSE FILE (Any Document):
By checking this box, I confirm that I have read