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Thanks for your interest in C100!

About
C100 is a non-profit, member-driven organization dedicated to supporting Canadian technology entrepreneurship and investment. C100 is comprised of a select group of Canadians based primarily in Silicon Valley, including executives of leading technology companies, experienced startup entrepreneurs and venture capital investors. C100 members are passionate about leveraging their collective experience, expertise and relationships to help mentor and grow a new generation of successful Canadian-led technology companies.

Background
Recognizing the current challenges in the Canadian technology and venture capital industries, C100 aims to harness the energy and expertise of a professional network of accomplished Canadian expatriates in Silicon Valley. These individuals share a passion for their Canadian heritage and a desire to give back to Canada. C100 is launching in March 2010 and is supported by member dues and private and public sponsorships. C100 operates in association with the Canadian Consulate General San Francisco/Silicon Valley.

Membership events include:
• Quarterly networking/discussion groups with prominent technology leaders
• Meetings with Canadian policymakers to advise on innovation policies
• Online networking for members and the broader Canadian tech community
• Identification and selection of the most promising Canadian technology companies
• Mentorship for top Canadian technology entrepreneurs
• Participation in entrepreneurial networks, programs and incubators in Canada

Please help us learn a little more about you through the short application below.

*
1. First, some quick demographic information:

First, some quick demographic information: Name:
Company:
City/Town:
State/Province:
ZIP/Postal Code:
Country:
Email Address:
Phone Number (optional):

*
2. Now, about your Canadian roots:
(it's ok, we're accepting of non-Canadians too, but you'd better brush up on your hockey trivia)

Now, about your Canadian roots: (it's ok, we're accepting of non-Canadians too, but you'd better brush up on your hockey trivia) Hometown (city,province):
Undergrad university/college:
Undergrad degree:
Masters university/college:
Masters degree(s):

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3. A little about your work experience:
(Please indicate your current company & title and attach the URL to your LinkedIn profile:)

A little about your work experience: (Please indicate your current company & title and attach the URL to your LinkedIn profile:) Current company
Current Title
URL Linked in profile (ex: http://www.linkedin.com/in/yourname):

*
4. What are your areas of sector and functional expertise?
(ex: Web 2.0, Enterprise Software etc.; Finance, Product, Business Development etc.)

What are your areas of sector and functional expertise? (ex: Web 2.0, Enterprise Software etc.; Finance, Product, Business Development etc.)

5. Who referred you to the C100? Or how did you hear about C100?

Who referred you to the C100? Or how did you hear about C100?

6. Would you like to be considered for Charter membership?

Charter Membership
In its initial year, C100 will be comprised of up to 100 Charter Members who are accomplished Canadian technology executives, entrepreneurs and investors. Charter Members are dedicated to helping advance Canadian technology entrepreneurship by mentoring promising companies and providing guidance to resources and partnerships in the technology industry. Charter Members are selected through a quarterly nomination process and contribute both time and capital to support the organization. C100 Charter Members include top executives of companies such as Cisco, EA, Facebook, Google, Microsoft and Oracle, successful start-up entrepreneurs, and venture investors representing more than $5 billion in investment capital.

General Membership
C100 manages a professional network on LinkedIn that is open to any qualified professional who supports the mission of the organization.

Charter members support the group through annual dues. General membership is free.

Would you like to be considered for Charter membership? Charter Membership In its initial year, C100 will be comprised of up to 100 Charter Members who are accomplished Canadian technology executives, entrepreneurs and investors. Charter Members are dedicated to helping advance Canadian technology entrepreneurship by mentoring promising companies and providing guidance to resources and partnerships in the technology industry. Charter Members are selected through a quarterly nomination process and contribute both time and capital to support the organization. C100 Charter Members include top executives of companies such as Cisco, EA, Facebook, Google, Microsoft and Oracle, successful start-up entrepreneurs, and venture investors representing more than $5 billion in investment capital. General Membership C100 manages a professional network on LinkedIn that is open to any qualified professional who supports the mission of the organization. Charter members support the group through annual dues. General membership is free. Yes, I'm interested in being considered for Charter membership

I am not interested in Charter membership, but would like to participate as a General member

I'm undecided

7. Why are you interested in joining C100? Is there anything in particular that you would like to highlight that would make you a great Charter member?

Why are you interested in joining C100? Is there anything in particular that you would like to highlight that would make you a great Charter member?

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8. C100 will organize mentoring activities for Canadian entrepreneurs and discussion/networking events for its members. Activities will include:
• Identification and selection of the most promising Canadian technology companies
• Mentorship for top Canadian technology entrepreneurs
• Participation in entrepreneurial networks, programs and incubators in Canada

Please indicate your level of interest in the following mentoring programs:

	Not interested	Somewhat interested	Very interested
Quarterly mentoring sessions (2hrs per quarter mentoring a new start-up)	*C100 will organize mentoring activities for Canadian entrepreneurs and discussion/networking events for its members. Activities will include: • Identification and selection of the most promising Canadian technology companies • Mentorship for top Canadian technology entrepreneurs • Participation in entrepreneurial networks, programs and incubators in Canada Please indicate your level of interest in the following mentoring programs: Quarterly mentoring sessions (2hrs per quarter mentoring a new start-up) Not interested	Quarterly mentoring sessions (2hrs per quarter mentoring a new start-up) Somewhat interested	Quarterly mentoring sessions (2hrs per quarter mentoring a new start-up) Very interested
Ongoing mentoring (building a relationship with a startup, meeting more frequently)	Ongoing mentoring (building a relationship with a startup, meeting more frequently) Not interested	Ongoing mentoring (building a relationship with a startup, meeting more frequently) Somewhat interested	Ongoing mentoring (building a relationship with a startup, meeting more frequently) Very interested

9. The high quality of C100 members is helped through referrals. Please let us know of other high quality individuals you wish to recommend.
(name & email address)

The high quality of C100 members is helped through referrals. Please let us know of other high quality individuals you wish to recommend. (name & email address)

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*1. First, some quick demographic information:

*2. Now, about your Canadian roots: (it's ok, we're accepting of non-Canadians too, but you'd better brush up on your hockey trivia)

*3. A little about your work experience:(Please indicate your current company & title and attach the URL to your LinkedIn profile:)

*4. What are your areas of sector and functional expertise? (ex: Web 2.0, Enterprise Software etc.; Finance, Product, Business Development etc.)