Entrepreneur Peer Group Information Question Title * 1. Full Name OK Question Title * 2. Business Name OK Question Title * 3. Gender Male Female Other (specify if desired) OK Question Title * 4. Email Address OK Question Title * 5. Telephone Number OK Question Title * 6. Home Address OK Question Title * 7. Business Address (if different from home) OK Question Title * 8. Residency status Canadian Citizen/Permanent Resident Other (please specify) OK Question Title * 9. Are you the business owner? Yes No OK Question Title * 10. Business Type Sole Proprietorship Parntership Incoporation OK Question Title * 11. How long have you been in business? OK Question Title * 12. Business' Annual revenue in the last full year? OK Question Title * 13. Number of Employees (if you have employees). Please indicate the number of Full Time and/or Part Time employees. OK Question Title * 14. Please provide a brief business description. OK Question Title * 15. What is your product or Service? OK Question Title * 16. What are your 3 biggest challenges? OK Question Title * 17. What do you want your business to look like in the next 3 years? OK Question Title * 18. What are you hoping to achieve by attending these peer groups? OK Question Title * 19. Do you have a preference on the advisor you are placed with? Yes No If yes, please explain OK SUBMIT