BOOT CAMP BUSINESS REGISTRATION 2019/2020

Thank you for your interest The Refinery, iLab's Business Accelerator for Female Founders.

Boot Camp Application Form

We will review your information and contact you about how we might best support your business goals. If you have any questions or need help with this form, we are happy to help:

theRefinery@communityilab.ca

ABOUT YOU
You are a female entrepreneur who runs a business in the Durham Region.

ABOUT US
Community Innovation Lab is a not-for-profit organization based in Durham Region. We address the social and economic gaps in communities through innovation and entrepreneurship. Our mission is to inspire, catalyze, and advance a community of entrepreneurs. We are an incubator for enterprising ideas and an accelerator for promising ventures.

BOOT CAMP
Our flagship program, The Refinery Boot Camp helps passionate women entrepreneurs who are ready to grow their businesses by providing the strategies, tools, and support they need to develop an action plan and achieve their fullest potential. The boot camp is an innovative 3-day deep-dive for exploring your business with other women business owners and a team of coaches. Participants gain the confidence and skills needed to grow revenue, pivot, or offer new services.

CONFIDENTIALITY
The information you provide will be kept confidential, i.e. your name will not appear unless you have given your express consent. The purpose of publishing your information is to promote your business. At any time, you may request that all or some of your information be removed The Refinery database.

CONTACT
The Refinery Team
TheRefinery@communityilab.ca | www.communityilab.ca

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* 1. CONSENT
I agree to register with Community Innovation Lab. I have made this decision based on the information I have read in the Information above. I have had the opportunity to receive any additional details I wanted about the program and understand that I may ask questions in the future.

Yes, I consent

No, not at this time

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* 2. First Name

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* 3. Last Name

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* 4. Phone Number (Personal)

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* 5. Email (Personal)

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* 6. Permission to publish your name in connection with your business information

I agree to my first and last name being published as it appears above in connection to my business information.

I do not agree to my first and last name being published as it appears above in connection to my business information.

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* 7. Stay informed about what's happening at the Community Innovation Lab. We respect your privacy and never share contact information or mailing lists with anyone – and we promise to keep all our emails short and sweet!

I consent to receiving updates from Community Innovation Lab by email

I do not want to receive updates

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* 8. How did you find out about the Boot Camp? (select all that apply)

Facebook

Instagram

Twitter

iLab Website

Friends/Family

Print Media

Event

Job Board

Community Event Calendar

Other (please specify)

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* 9. Do you identify as one of the following?

Woman

Member of a visible minority

Indigenous

Youth

Senior (55+)

Immigrant / New Canadian

Differently abled

Prefer not to answer

None of the above

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* 1. CONSENTI agree to register with Community Innovation Lab. I have made this decision based on the information I have read in the Information above. I have had the opportunity to receive any additional details I wanted about the program and understand that I may ask questions in the future.

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* 2. First Name

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* 3. Last Name

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* 4. Phone Number (Personal)

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* 5. Email (Personal)

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* 6. Permission to publish your name in connection with your business information

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* 7. Stay informed about what's happening at the Community Innovation Lab. We respect your privacy and never share contact information or mailing lists with anyone – and we promise to keep all our emails short and sweet!

Question Title

* 8. How did you find out about the Boot Camp? (select all that apply)

Question Title

* 9. Do you identify as one of the following?

* 1. CONSENT
I agree to register with Community Innovation Lab. I have made this decision based on the information I have read in the Information above. I have had the opportunity to receive any additional details I wanted about the program and understand that I may ask questions in the future.