Personal Registration Form

Please fill out the following fields to the best of your ability, then click the 'Submit' button at the bottom of the page.

First name*

Last name*

Email*

Phone number

Job title*

Company name*

City*

Province/State*

Country*

Personal LinkedIn URL

Personal Twitter username

Preferred language

Link to Your Personal Photo

By sharing this link, you are providing the Canadian Robotics Council permission to use the associated photo on their website.