Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Preferred phone number *

(###)

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Secondary phone number

(###)

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Do you currently invest in any hedge funds? *

Yes

No

I don't know

Are you a "qualified client", as defined by Rule 205-3 of the Investment Advisers Act of 1940? (See criteria below.) *

Yes

No

I don't know

If yes, please check all of the criteria that apply:

A natural person who has individual net worth, or who has joint net worth with his/her spouse, that exceeds $2 million as of this date, not counting the value of his/her primary residence.

A natural person who plans to invest $1 million or more in this fund.

An entity owned entirely by accredited investors, in which each of the entity’s owners has a net worth that exceeds $2 million, not counting the value of his/her primary residence.

Are you an accredited investor, as defined by Rule 501(a) of Regulation D? (See criteria below.) *

Yes

No

I don't know

If yes, please check all of the criteria that apply:

A natural person who has individual net worth, or who has joint net worth with his/her spouse, that exceeds $1 million as of this date, not counting the value of his/her primary residence.

A natural person who has individual income in excess of $200,000, or who has joint income with his/her spouse in excess of $300,000, for each of the two most recent years. For the current year, that person has a reasonable expectation of individual income in excess of $200,000, or of joint income with his/her spouse in excess of $300,000.

A business in which all the equity owners are accredited investors.

A bank, insurance company, registered investment company, business development company, or small business investment company.

A trust with assets in excess of $5 million, not formed to acquire the securities offered, whose purchases a sophisticated person makes.

A charitable organization, charitable corporation, or charitable partnership with assets in excess of $5 million.

An employee benefit plan, within the meaning of the Employee Retirement Income Security Act, if a bank, an insurance company, or a registered investment advisor makes the investment decisions, or if the plan has total assets in excess of $5 million.