BASIC INFORMATION

First Name

Last Name

Personal Email

City of Residence

State/Province (e.g.: CA, NY)

Country of Residence

Country

PROFESSIONAL INFORMATION

What role do you currently hold? (Note: applicants not in one of the below categories may not be eligible for C100 Membership at this time and are subject to further review. If you lead an agency, consultancy, or other professional service organization, please consider joining C100's Partner program)

Job Title

Company/Organization

Work Email

Tell us about yourself! Who you are, a short bio, and some of your proudest career accomplishments.

What are you looking forward to bringing to the C100 Membership community? Tell us why you're interested in supporting C100 as a Member, how you'd like to use your Membership, and where you would like to "pay it forward" in the community.

BIOGRAPHICAL INFORMATION

Educational Background

Undergraduate Institution

Undergraduate Degree

Year Graduated

Graduate Institution

Graduate Degree

Year Graduated

Demographic Information

Canadian Hometown (if applicable)

Home Province/Territory

Other Gender Identity:

What was your first language, spoken in the home?

EnglishFrenchOther, please specify:

Other Language:

Do you identify as LGBTQ2IA+?

YesNoPrefer Not to Answer

What are your non-work passions?

Anything else you'd like to share?

MEMBERSHIP PRINCIPLES

By applying to C100's Membership, you are agreeing to the following Membership Principles:

Hands-On Support for Canadian Entrepreneurs and Rising Leaders: As C100 members, we hold unique and in-demand expertise. The success of the network rests on the nexus of our skills and the needs of those we support. The more we put into supporting the community, the more value we will gain as well.
Active Participation: We commit to being active participants in C100's mission and programs. It is through convening the community that serendipitous relationships can be made, existing ones deepened, and the network strengthened.
Accountability and Responsiveness: We value responsiveness and accountability in other members, and therefore we uphold the same standards for ourselves.
Referrals: We make best efforts to refer new members, entrepreneurs and other partners who fit with C100's mission.
Professional Conduct: We maintain the highest standards of conduct and engage in C100 events and the broader community at large in a professional manner, acting with integrity and respectfulness when interacting with all staff, members, guests and the general public.
Non-Solicitation: We refrain from proactively soliciting our services, products or employment with other members unless invited or prompted to do so.

C100 boasts a talented, dynamic and committed membership. By becoming C100 members, we are committing to serve Canadian entrepreneurs and the global Canadian tech community, to uphold C100's values, and to work together with fellow members to advance the cause.

Membership Principles Agreement

I have read and agree to conduct myself in accordance with the C100 Membership Principles

Mailing Address (please enter the address that is best for you to recieve packages)

Street Address

Mailing City

Mailing Country

Mailing State/Province

Mailing Postal Code / Zip Code

Phone Number (mobile or place to contact you)

Nominated by another member?

Yes

SPONSOR INFORMATION

In order to be considered for membership, you must be sponsored by at least one active Member or Charter Member.

Please list your sponsor names and emails below. To make for a fast and easy process, you should obtain the support of your sponsor before submitting your application. Once validated, your membership will be activated. Note: This process may take several days or weeks.

Don’t know any members yet? No worries! You may still submit an application form and find a sponsor later. Please join us at an upcoming C100 event to meet the community and learn more about membership.

Please note, having a sponsor does not guarantee acceptance.

Sponsor 1 First Name

Sponsor 1 Last Name

Sponsor 1 Email

Sponsor 2 First Name

Sponsor 2 Last Name

Sponsor 2 Email

PAYMENT INFORMATION

To finalize your membership application, please submit payment information for your membership dues upon sponsorship confirmation. Dues are $650 USD/year.

Note: You will not be an active C100 Member or charged for your first membership installation until your listed sponsor has approved your membership application and C100 has approved your application for eligibility.

All membership payments are set to auto-renew on the same day and month of your initial membership approval date. Membership dues are nonrefundable and nontransferable. Should you wish to cancel your membership prior to your auto-renewal, you may do so by emailing membership@thec100.org.

I consent to be charged if my application is approved.

Membership Annual Payment: $650/year

Name on Card

Card Number

Code

Billing Email

Billing Email (lower)

Is the Mailing Address listed above the same as the Billing Address for your credit card?

Billing Address

Billing Address Line 1

Billing Address Line 2

Billing City

Billing State/Province

Billing Postal/Zip Code

Mailing List

Please include me in communications about C100 events and programs