Membership Application Membership application Membership Application Our membership gives you the opportunity to join the Norrsken House community together with all its benefits and offerings. Please make sure you read what it includes on our website: https://www.norrskenhouse.org/ Company info Company name * Company URL Industry * Agriculture Forestry and Wildlife Business and Information Construction and Engineering Education Finance and Insurance Food and Hospitality Gaming Health services Environment / Natural resources Realestate and Housing Security and Legal / Safety Transportation Other Describe your company * Maximum 300 characters Why do you want to sit at Norrsken House? * Maximum 300 characters What can you contribute with to the community? * Maximum 300 characters Team How many seats do you need? * How many team members are you in total? * This figure should also include other team-members who are not applying for a seat in the house Who are the company co-founders? How many co-founders are in your team? * 1 2 3 4 5 Co-founder #1 Full name * LinkedIn/Resume * Co-founder #2 Full name * LinkedIn/Resume * Co-founder #3 Full name * LinkedIn/Resume * Co-founder #4 Full name * LinkedIn/Resume * Co-founder #5 Full name * LinkedIn/Resume * Membership Membership type * Entrepreneur (startup) Intermediary Investor If accepted, which month would you like to start? * January February March April May June July August September October November December Do you want to answer questions about your impact to be eligible for a potential discount? * Yes No Impact We view our impact tech members as investments. It costs the Against Malaria Foundation (AMF) approximately $3,300 to save a human life. In other words, the opportunity cost of one year of discounted membership at Norrsken House is a human life or more. We offer you subsidized membership instead of donating to AMF because we believe that the positive impact you will create in the society through your tech solution will not only save one life but millions. In order to justify our investment in you and your organization, we expect you to fill out this form diligently and report on your impact and business KPIs when requested quarterly. Vision & Product What is your vision in one sentence? * Guiding question: What would the world look like if you succeeded? Example: A sustainable planet where we consume within our means What is the challenge you are addressing? * Guiding question: Why is your solution needed? Example: Owning is the default - our natural behaviour is to buy rather than borrow. Main reasons for it 1) it is too cheap to buy-the cost of environment is not included 2) our society assigns status to owning How do you aim to solve this challenge? * Guiding question: What is your solution to the challenge? Remove barriers to borrowing on-demand, make borrowing as easy as buying. What is your specific product? How is it related to technology? * Example: An online platform that makes borrowing easy. What is innovative about your product? * Guiding question: Why is it contributing more than what would have existed anyhow? Example: Creating a new market for borrowing (peer-to-peer) Which of the following features best describe your product progress? * Not started / Idea Prototyping Beta launch / MVP Launched 2.0 or beyond Other Describe your impact You probably just started, and these questions might be hard to answer, but just give us estimations in that case. How much How much of the effect occurs in the time period? Intensity of effect (1 = Marginal / 4 = Deep) * 1 2 3 4 Volume of effect (1 = For a few / 4 = For many) * 1 2 3 4 Duration of effect (1 = Short term / 4 = Long term) * 1 2 3 4 Time to effect (1 = Slow / 4 = Quick) * 1 2 3 4 Who Who experiences the effect and how underserved are they in relation to the outcome? Beneficiary (1 = Well served / 4 = Underserved) * 1 2 3 4 Contribution How does the effect compare and contribute to what is likely to occur anyway? Contribution (1 = Low / 4 = High) * 1 2 3 4 Risk Which risk factors are significant and how likely is it that the outcome is different from the expectation? Risk (1 = High / 4 = Low) * 1 2 3 4 What are the metrics of your impact? (3 KPIs) KPI #1 * ex: # of unique phones using the service KPI #2 * ex: # accurate weather forecasts sent KPI #3 * ex: retention rate among farmers (1-3 mths) Company vision What is your vision in once sentence? * Example: Full transparency What is your specific product? How is it related to technology? * Example: we provide hyper-local weather updates, via SMS, based on GPS location. What is the challenge you are addressing? * Example: Big service providers are taking advantage of their position and provide insufficient transparency to what they are doing with their customers money What is your solution? * Example: a new easy-to-use insurance solution with full transparency into where the money goes Financial performance Key source of income * Sales to businesses (b2b) Sales to customers (b2c) Funding from investors Donations/grants Founders and employees I don't have any income from this What most accurately describes your current funding situation? * Pre-seed Seed Series A Not interested in external investors What is your current financial status? * Pre-revenue (no self-generated revenues yet) (Generating revenue but) making losses Breaking even Making a profit How big are your needs for: Please review our meeting room guidelines to see if Norrsken House fits your company's needs for meeting room capacity. Low = 1h / week Medium = 2.5h / week High = 8h / week Meeting rooms * Low Medium High Conference Rooms * Low Medium High Photo/Video studio * Low Medium High Event space * Low Medium High Standing desks * Low Medium High Contact details Full name * First name * Last name * Mobile number * Email * Billing details VAT Number * Company Address (*required) City State/Province Zip/Postal Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Colombia Comoros Congo Costa Rica Côte d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France French Guiana French Polynesia Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Norway Northern Mariana Islands Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Yemen Zambia Zimbabwe Country Other Do you know anyone at Norrsken House - who? Enter their first and last name Have you applied, or are you planning to apply, for an investment from the Norrsken Founders Fund? Yes No Maybe How did you hear about us? * Friend Colleague News Social media Someone at Norrsken Other Additional attachments Uploading Files. Please Wait. Drop a file here or click to upload Choose File Maximum upload size: 40.96MB ex: pitch deck, product PDF, research Terms & Conditions I confirm that I took note of and accept the General Terms & Conditions and the Norrsken House rules as to be found here: http://wiki.norrskenhouse.org/artikel/house-rules/ Agreement * I accept Norrsken House Rules and the Terms & Conditions Ethical code of conduct * I hereby guarantee that my team has a clearly formulated ethical code of conduct including, but not limited to, sustainability policies - focused on environmental aspects, social aspects and governance, health & safety, employee regulations, protection from discrimination and harassment, guidelines against bribery and protection from retaliation against members that raise compliance concerns. Make sure that all the above information is correct before clicking next.