infraNET Partnership Application Form

Please completely fill out the application form below and choose the Submit button. You will be contacted by the infraNET Project office upon receipt of a partnership application. If you do not receive a confirmation notice within a week, please telephone (519) 888-4074.

Date:
Company Name:
Primary Contact:
Job Title:
Department:
Address:
City:		Province/State:
Country:		Postal Code:
Tel:		Fax:
E-mail Address:
URL:

Business Category		Estimated Annual Revenue
Computer and IS Education Financial/Banking Government Legal/Medical Services Manufacturing Professional Services Other:		Less than $1 million $1-$5 million $5-$10 million $10-$25 million $25-$50 million $50-$100 million $100+ million
Years in Operation		Geographic Area of Service
Less than 1 year 1-4 years 5-10 years 10+ years		Local Regional National International
Type of Partnership
infraNET Corporate Partner infraNET Research Partner infraNET UW Partner

Brief Description of Your Organization

Interest in the infraNET Project