Check Box(es) that Apply:
Promoter
Beneficial Owner
Executive Officer
Director
General and/or Managing Partner
______________________________________________________________________________
Full Name (Last name first, if individual)
______________________________________________________________________________
Business or Residence Address (Number and Street, City, State, Zip Code)
Check Box(es) that Apply:
Promoter
Beneficial Owner
Executive Officer
Director
General and/or Managing Partner
______________________________________________________________________________
Full Name (Last name first, if individual)
______________________________________________________________________________
Business or Residence Address (Number and Street, City, State, Zip Code)
Check Box(es) that Apply:
Promoter
Beneficial Owner
Executive Officer
Director
General and/or Managing Partner
______________________________________________________________________________
Full Name (Last name first, if individual)
______________________________________________________________________________
Business or Residence Address (Number and Street, City, State, Zip Code)
Check Box(es) that Apply:
Promoter
Beneficial Owner
Executive Officer
Director
General and/or Managing Partner
______________________________________________________________________________
Full Name (Last name first, if individual)
______________________________________________________________________________
Business or Residence Address (Number and Street, City, State, Zip Code)