Sec Form 1a Regulation A Offering Statement (Page 18 of 29) in pdf

Name

Position

Age

Term of Ofﬁce(1)

Approximate hours per

week for part-time

employees(2)

Executive Ofﬁcers:

Directors:

Signiﬁ cant Employees:

(1) Provide the month and year of the start date and, if applicable, the end date. To the extent you are

unable to provide speciﬁc dates, provide such other description in the table or in an appropriate

footnote clarifying the term of ofﬁce. If the person is a nominee or chosen

to become a director or executive ofﬁcer, it must be indicated in this column or by footnote.

(2) For executive ofﬁcers and signiﬁcant employees that are working part-time, indicate approximately

the average number of hours per week or month such person works or is anticipated to work. This

column may be left blank for directors. The entire column may be omitted if all those listed in the table

work full time for the issuer.

In a footnote to the table, brieﬂy describe any arrangement or understanding between the persons described

above and any other persons (naming such persons) pursuant to which the person was or is to be selected to his

or her ofﬁce or position.

Instructions to Item 10(a):

1. No nominee or person chosen to become a director or person chosen to be an executive ofﬁcer who

has not consented to act as such may be named in response to this item.

2. The term “executive ofﬁ cer” means the president, secretary, treasurer, any vice president in charge

of a principal business function (such as sales, administration, or ﬁnance) and any other person who performs

similar policy making functions for the issuer.

3. The term “signiﬁ cant employee” means persons such as production managers, sales managers, or

research scientists, who are not executive ofﬁ cers, but who make or are expected to make signiﬁcant contribu-

tions to the business of the issuer.

(b) Family relationships. State the nature of any family relationship between any director, executive ofﬁ cer,

person nominated or chosen by the issuer to become a director or executive ofﬁcer or any signiﬁ cant employee.

Instruction to Item 10(b):

The term “family relationship” means any relationship by blood, marriage, or adoption, not more re-

mote than ﬁrst cousin.

rector, executive ofﬁcer, person nominated or chosen to become a director or executive ofﬁcer, and each signiﬁ-

Sec Form 1a Regulation A Offering Statement Page 18