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* 1. Company Name:

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* 2. Company Website:

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* 3. Name (Primary Contact):

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* 4. Email (Primary Contact):

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* 5. Additional Contacts For:

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* 8. Capital:

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* 10. Business Description:

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* 12. Service Providers - Who do you use for:

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* 13. Can you please tell us what you hope to gain by joining the BC Tech community and what accessing this free program means to your startup?

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* 14. I understand that my participation in this program, including company name & logo, may be used in marketing materials to promote BCTech4Startups.

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* 15. If you were an existing BC Tech Startup member and are applying to have your membership reviewed for inclusion in this program, please indicate that here so that we can connect this application to your existing membership.

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