Partnership Application CIOCAN Partnership Application Partnership Application Form Please complete the following information to register your application. Once you have selected the category under which you wish to apply, complete the company information along with the relevant sections of the application. For organizations that do not meet our partner criteria, a written response will be provided within 2 weeks. Organizations that merit further assessment will be contacted directly. Incomplete applications will be rejected. Section 1: Company Information Required for all categories of application Organization Name * Street Address * City and Province or State * Postal Code or Zip Code * Organization Web Site * Primary Contact Name * Primary Contact Title * Contact Email Address * Contact Work Phone Number * Contact Cell Phone Number What is your company's main business? * For which category of partnership are you applying? * Industry Events Academic Research Media Section 2: Objectives To be completed by all applicants Outline your objectives for a CIOCAN partnership * Is there a time sensitivity to your application? If so, please explain. Section 3: Event Partnership Only complete if you are applying under this category. Tell us about the event(s) for which you wish for CIOCAN to partner with you Date(s) and Location(s) of the event(s) Is your event national in scope? * Yes No Which of our chapter locations are you interested in? * Montreal Toronto Manitoba Calgary Edmonton Vancouver Check all that apply What is the role you want CIOCAN to fulfill in this event? Section 4: Research Partnership Outline your objectives for a research project with CIOCAN What is the research topic you would like to pursue with us? Has your organization conducted research and / or published on this topic before? Provide examples. Once completed, what media will be included in the publishing activity? Print Webinar Presentation Video Podcast Check all that apply Section 5: Academic Describe the educational program you propose and key milestones you anticipate If you are human, leave this field blank.