Profile application

1. Company Information

Contact name
Title
Company name
Street address
City
Province/State
Postal code/Zip
Telephone Extension
Best time to reach you (e.g. Mondays 7 to 8 am)
Facsimile
E-mail
Current URL
Current industry sector
Current business/profession
Number of years in this business/profession

2. Interests

Indicate your reasons for investigating this opportunity.
1 = least important/5 = most important

Business expansion   Career search
yes 1 2 3 4 5 no yes 1 2 3 4 5 no
Education Colleague connection
yes 1 2 3 4 5 no yes 1 2 3 4 5 no
R&D member Social connection
yes 1 2 3 4 5 no yes 1 2 3 4 5 no
Associate Mentor connection
yes 1 2 3 4 5 no yes 1 2 3 4 5 no

3. Target market

Please identify your current or ideal target market(s).

General public
Other businesses
Both

Describe your ideal client demographics.
a) General public (e.g. gender, age group, education, occupation, income, marital status, family size, geographical location).

b) Other businesses (e.g. size of business, annual sales, number of employees, legal entity, geographical location, industry sector).

4. Service or product

In 50 words or less describe your product or service.
What is your competitive advantage?

5. Testimonial

List your best testimonial here. Provide name and telephone number of advocate.

6. Relevant education

University education
 yes no

Please state the following:

Certification/Designation/Degree relevant to your current profession/business
Year of completion
Registration Number
Name of licensing body

7. Languages spoken

List here.

8. Favourite quote

Specify anonymous if author is unknown.

9. Approach or philosophy

Include a personal or business operating principle that has significant meaning for you.

10. Purpose

Identify the primary reason you are in your current business/profession.

11. Values

Identify three of your most important values.

12. Challenges

What is your most pressing business challenge?

13. Additional information

Please submit your bio or other pertinent data here.

15. Referral

Should you wish to refer a friend or business colleague to our site, please complete the following referral information:

Full name of your friend/colleague
Their e-mail address

16. Connection

Thank you for your submission; we will contact you.

     

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