Form

Peer Forum: Application Form

Thank you for your interest in Peer Forum. Please complete this application form to be considered for participation in the program.

Contact Information

First Name*

Last Name*

Job title*

Email*

Phone Number*

Company Information

Company name*

What year was your company founded?*

Current full-time and part -time employee headcount*

How many CXOs are in the company?*

2024 Revenue*

500K - 1M

1M - 2M

2M - 4M

4M +

Do you have a Board of Directors?*

Yes

No

How much dilutive and non-dilutive capital have you raised to date?*

Challenges:

Briefly describe your operating as well as personal challenges.*

How do you envisage the peer forum will help you with these challenges?*

Have you been part of a peer group forum before?*

Yes

No

Are you able and willing to attend at least 6 of 8 forum sessions per year?*

Yes

No

Do you have any dietary restrictions?*

Are you in any way affiliated with a Canadian technology company other than your current one? We need to check for competitive conflicts.*

Yes

No

The sessions are private and confidential. If accepted as a forum member, do you agree keep keep all communications and information about your peers and their companies confidential?*

I agree

Is there anything else you want to share with us?

Note that this program has a limited capacity and submitting this form doesn’t guarantee your participation.