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.

CIOCAN Partnership Application

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 *

Confirm 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? * IndustryEventsAcademicResearchMedia

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: 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 4: Academic

Describe the educational program you propose and key milestones you anticipate

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