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Submitted URL: https://bit.ly/46tElWw
Effective URL: https://share.hsforms.com/1PckkHYesTvSvsB5OX-oQYQcw4im
Submission: On March 04 via manual from SG — Scanned from SG
Effective URL: https://share.hsforms.com/1PckkHYesTvSvsB5OX-oQYQcw4im
Submission: On March 04 via manual from SG — Scanned from SG
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<div data-hsfc-id="RichText" style="font-size: 14px; color: rgb(51, 71, 91);"><img src="https://21654238.fs1.hubspotusercontent-na1.net/hubfs/21654238/SECONDARY%20LOGO%20flat%20color%20ursamin%20logo%203@4x.png"
style="max-width: 100%; max-height: 100%; display:block; margin-left:auto; margin-right:auto;" data-img-aspect-ratio="4.607843137254902" alt="SECONDARY LOGO flat color ursamin logo 3@4x" width="470" data-img-width="470"
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<h1 style="text-align: center;">Advisory Board & Investment Opportunity Application</h1>
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<div data-hsfc-id="RichText" style="font-size: 14px; color: rgb(51, 71, 91);"><span style="font-size: 16px; color: #000000;">Thank you for your interest in applying to be an advisor & investor at Ursamin. With your help, we can
revolutionize care for patients living with multiple chronic conditions, and change the future of the clinicians who serve them. <br><br></span><span style="font-size: 16px; color: #000000;">Over 25% of US adults have three or more
chronic illnesses,. And this number will grow 99% in the next 20 years. These patients have the worst outcomes, the highest rate of suicide, and the highest rate of death, due to trying to deal with the fragmented health care system.
Our mission is to provide these patients a better experience with the healthcare system, by streamlining their journey, improving outcomes, with the added benefit of reducing the administrative burden on clinicians and health
systems in the process. <br><br></span><span style="font-size: 16px; color: #000000;">We are currently recruiting advisory board members who would also consider participating as an angel investor into our
startup. <br><strong><br>Responsibilities of advisors & investors include: </strong></span><br>
<ul>
<li><span style="font-size: 16px; color: #000000;"> Providing feedback and guidance to the management team & other advisors (via email, Zoom) on company growth and strategies.</span></li>
<li><span style="font-size: 16px; color: #000000;">Making helpful introductions to potential customers or partners.</span></li>
</ul>
<span style="font-size: 16px; color: #000000;"><strong>Benefits to advisors & investors include: </strong></span><br>
<ul>
<li><span style="font-size: 16px; color: #000000;">Being issued stock options in exchange for spending a few hours on the company each month</span></li>
<li><span style="font-size: 16px; color: #000000;">Participating as an angel via an IRA/401K with a $25K+ investment.</span></li>
</ul>
<span style="font-size: 16px; color: #000000;">Ursamin collaborates with physicians to streamline care coordination, reduce administrative tasks, and enhance patient care time. Our care coordination platform encourages teamwork, bringing
patients and care teams together for collaborative decision-making and workload sharing. <br><br>Before you apply, we encourage you to watch a video of our product
<a href="https://www.youtube.com/watch?v=O0t9VzOLgjk&t=14s" target="_blank" rel="noopener">HERE</a> and we also encourage you to look at our company pitch deck
<a href="https://bit.ly/47ymUFc" target="_blank" rel="noopener">HERE</a>.<br><br>Please fill out this form if you are interested in joining our advisory board! Someone from our team will be in touch.</span>
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<div class="hs-form__field hs-form__field-firstname hs-firstname"><label id="firstname-label" for="firstname-input" class="hs-form__field__label" data-required="true"><span lang="en">First Name</span><span
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<div class="hs-form__field hs-form__field-phone hs-phone"><label id="phone-label" for="phone-input" class="hs-form__field__label" data-required="true"><span lang="en">Phone Number</span><span
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<div class="hs-form__field__phone"><input id="phone-input" class="hs-form__field__input" type="tel" name="phone" required="" autocomplete="tel" inputmode="tel" aria-invalid="false" aria-required="true" value=""></div>
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<div class="hs-form__field hs-form__field-how_do_you_think_you_could_contribute_to_ursamin_s_advisory_board_ hs-how_do_you_think_you_could_contribute_to_ursamin_s_advisory_board_"><label
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think you could contribute to Ursamin's advisory board?</span><span class="hs-form__field__label__required">*</span></label><input id="how_do_you_think_you_could_contribute_to_ursamin_s_advisory_board_-input"
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<div
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class="hs-form__field__label" data-required="true"><span lang="en">Would you strongly consider making a $25,000+ angel investment or more in Ursamin's current funding round in the next 60 to 90 days? Note that investors can use an
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<option label="No, I would not consider investing. " value="No, I would not consider investing.">No, I would not consider investing. </option>
<option label="Yes, I would strongly consider making a $25K angel investment." value="Yes, I would strongly consider making a $25K angel investment within the next 60 to 90 days.">Yes, I would strongly consider making a $25K angel
investment.</option>
<option label="Yes, I would strongly consider making a $50K angel investment." value="Yes, I would strongly consider making a $50K angel investment.">Yes, I would strongly consider making a $50K angel investment.</option>
<option label="Yes, I would strongly consider making a $75K angel investment." value="Yes, I would strongly consider making a $75K angel investment.">Yes, I would strongly consider making a $75K angel investment.</option>
<option label="Yes, I would strongly consider making a $100K+ angel investment." value="Yes, I would strongly consider making a $100K+ angel investment.">Yes, I would strongly consider making a $100K+ angel investment.</option>
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<div class="hs-form__field hs-form__field-if_you_said_yes_to_investing__why_are_you_interested_in_investing_in_ursamin_ hs-if_you_said_yes_to_investing__why_are_you_interested_in_investing_in_ursamin_"><label
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data-required="false"><span lang="en">If you said yes to investing, why are you interested in investing in Ursamin?</span></label><textarea id="if_you_said_yes_to_investing__why_are_you_interested_in_investing_in_ursamin_-input"
class="hs-form__field__input" name="if_you_said_yes_to_investing__why_are_you_interested_in_investing_in_ursamin_" aria-invalid="false"></textarea></div>
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<div class="hs-form__field-row__column">
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data-required="false"><span lang="en">If you said no to investing, why are you not interested in investing in Ursamin? For our learning purposes, it would be really helpful.</span></label><input
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<div
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class="hs-form__field__label" data-required="true"><span lang="en">Are you an accredited investor? The SEC defines accredited investors as individuals with a $200K+ income OR $300K+ income with a spouse or $1M net worth.</span><span
class="hs-form__field__label__required">*</span></label><select id="are_you_an_accredited_investor__the_sec_defines_accredited_investors_as_individuals_with_a__200k__i-input" class="hs-form__field__input is-placeholder"
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<option label="Please Select" disabled="" value="">Please Select</option>
<option label="Yes, I am an accredited investor." value="Yes, I am an accredited investor.">Yes, I am an accredited investor.</option>
<option label="No, I am not an accredited investor." value="No, I am not an accredited investor.">No, I am not an accredited investor.</option>
</select></div>
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<div class="hs-form__actions"><button type="submit" name="Submit Advisory Board Application" class="hs-form__actions__submit" lang="en">Submit Advisory Board Application</button></div>
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<div id="46c98093-99f4-4849-8e45-c2293088767c-live-region-content" class="hs-form__visually-hidden" aria-live="polite"></div>
</form>Text Content
Skip to form ADVISORY BOARD & INVESTMENT OPPORTUNITY APPLICATION Thank you for your interest in applying to be an advisor & investor at Ursamin. With your help, we can revolutionize care for patients living with multiple chronic conditions, and change the future of the clinicians who serve them. Over 25% of US adults have three or more chronic illnesses,. And this number will grow 99% in the next 20 years. These patients have the worst outcomes, the highest rate of suicide, and the highest rate of death, due to trying to deal with the fragmented health care system. Our mission is to provide these patients a better experience with the healthcare system, by streamlining their journey, improving outcomes, with the added benefit of reducing the administrative burden on clinicians and health systems in the process. We are currently recruiting advisory board members who would also consider participating as an angel investor into our startup. Responsibilities of advisors & investors include: * Providing feedback and guidance to the management team & other advisors (via email, Zoom) on company growth and strategies. * Making helpful introductions to potential customers or partners. Benefits to advisors & investors include: * Being issued stock options in exchange for spending a few hours on the company each month * Participating as an angel via an IRA/401K with a $25K+ investment. Ursamin collaborates with physicians to streamline care coordination, reduce administrative tasks, and enhance patient care time. Our care coordination platform encourages teamwork, bringing patients and care teams together for collaborative decision-making and workload sharing. Before you apply, we encourage you to watch a video of our product HERE and we also encourage you to look at our company pitch deck HERE. Please fill out this form if you are interested in joining our advisory board! Someone from our team will be in touch. First Name* Last Name* Email* Phone Number* LinkedIn URL* How do you think you could contribute to Ursamin's advisory board?* Would you strongly consider making a $25,000+ angel investment or more in Ursamin's current funding round in the next 60 to 90 days? Note that investors can use an IRA/401K to invest.*Please SelectNo, I would not consider investing. Yes, I would strongly consider making a $25K angel investment.Yes, I would strongly consider making a $50K angel investment.Yes, I would strongly consider making a $75K angel investment.Yes, I would strongly consider making a $100K+ angel investment. If you said yes to investing, why are you interested in investing in Ursamin? If you said no to investing, why are you not interested in investing in Ursamin? For our learning purposes, it would be really helpful. Are you an accredited investor? The SEC defines accredited investors as individuals with a $200K+ income OR $300K+ income with a spouse or $1M net worth.*Please SelectYes, I am an accredited investor.No, I am not an accredited investor. Submit Advisory Board Application