Advancing Women’s Leadership Program - Business Registration Form

Advancing Women’s Leadership Program - Business Registration Form

Thank you for your interest in our program! Please complete the following information to register.
1. First Name:*
2. Last Name:*
3. Business Name (Business/Organization Name):*
4. Email Address:*
5. Position/Title within the Company:*
HIDDEN Which languages are you comfortable communicating in? (Select all that apply)*

EnglishFrench
6. Which languages are you comfortable communicating in? (Select all that apply)*

EnglishFrench
7. Range of Number of Employees within the Business:*

1-1011-5051-100101-500501+
8. City of Business Operation:*
9. Province of Business Operation:*

OntarioAlbertaBritish ColumbiaQuebecManitoba
10. Industry/Sector:*

CleantechHealthBiotechAgri-foodManufacturingOther:
11. Business Structure:*

Sole ProprietorshipPartnershipCorporationCooperativeLimited Liability Company (LLC)Non-ProfitOther:
12. How Did You Hear About the Program?*

WebsiteEmailFacebookLinkedInInstagramReferralOther (please specify):
13. Gender Identity:*

WomanManNon-binaryPrefer not to sayPrefer to self-describe:
14. To help us ensure the diversity and inclusivity of our program, we invite you to share your racial or ethnic identity. This information is collected confidentially and will only be used to evaluate our outreach efforts and meet equity goals. Your honesty helps us create better opportunities and ensure meaningful representation.*

Indigenous (First Nations, Métis, Inuit)BlackEast AsianSouth AsianSoutheast AsianMiddle EasternLatin AmericanWhitePrefer not to sayOther:
15. Sexual Orientation:*

2SLGTBQ+HeterosexualPrefer not to sayPrefer to self-describe:
16. Refugee/Immigrant Status:*

RefugeeImmigrantNeitherPrefer not to say
17. Would you be interested in participating in the mentorship portion of this program?

YesNo
Disclaimer
Please note: The Advancing Women’s Leadership Program connects mentors and mentees for learning and support. Mentors and mentees are responsible for their own words, actions, and activities as they are based on their own experience and expertise. The views and advice shared are their own and do not necessarily reflect those of ICTC. ICTC is not liable for the advice, conduct, or external activities of either mentors or mentees.

By registering, you agree to receive information about this program and other ICTC programs or initiatives that may be relevant to you or your business. You may opt out of ICTC program-related emails at any time by contacting us at womenintech@ictc-ctic.ca
18. What topics you would like to receive mentorship on?*
Should be Empty:

Advancing Women’s Leadership Program - Business Registration Form

Disclaimer