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* 1. Company Name

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* 2. Primary Contact Name

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* 3. Title

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* 4. EMail

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* 5. Phone

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* 6. Mailing Address

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* 7. FAX

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* 9. How did you hear about ICI Society?

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* 10. Describe your business

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* 11. How will the ICI Society Member data be used? (Note: Please read the "General Terms and Conditions" and "ICIS Membership Policy") e.g. Will the data support your existing business/datasets? Will it streamline internal business processes?  Will it be an additional datasets? Will it allow you to provide additional services?

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* 12. Will data be provided externally from your organization to 3rd parties?  If so, in what format?  ie. map backdrop, hardcopy form, raster information?

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* 13. For those members that are planning to access utility datasets, it is required that the data be stored on servers, including backup storage, located within Canada.   Are your organization's servers stored in Canada?

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* 14. What areas of the province are of interest to your company

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* 15. What data does your company own and is will to share with ICI Society Members?

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* 16. Does your organization have any professional expertise that they are will to share with ICI Society?

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* 17. Will there be any restrictions on the data other than those imposed by the DSLA?

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* 18. Additional Comments

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* 19. Name of Signing Authority

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* 20. Title

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* 21. Address - if different than above

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* 22. EMail - if different from above

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* 23. Phone - if different from above

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* 24. Fax - if different from above

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