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Your Contact Information First Name * Last Name * Email Address * Telephone(Optional) Include Country code and City code Nationality * --- Select Country --- Canada Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Coral Sea Islands Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Cape Verde Central African Republic Chad Chile China Colombia Comoros Congo-Kinshasa Congo-Brazzaville Costa Rica Cote d Ivoire (Ivory Coast) Croatia Cuba Northern Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia South Ossetia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea (North) Korea (South) Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Pridnestrovie (Transnistria) Monaco Mongolia Montenegro Morocco Mozambique Myanmar (Burma) Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somaliland South Africa Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Tajikistan Tanzania Thailand Timor-Leste (East Timor) Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Viet Nam Yemen Zambia Zimbabwe ----------------- Taiwan Christmas Island Cocos (Keeling) Islands Heard Island and McDonald Islands Norfolk Island New Caledonia Clipperton Island Mayotte Guadeloupe Saint Pierre and Miquelon Wallis and Futuna French Southern and Antarctic Lands Bouvet Island Cook Islands Niue Tokelau Guernsey Isle of Man Jersey Anguilla Bermuda British Indian Ocean Territory British Sovereign Base Are British Virgin Islands Cayman Islands Falkland Islands (Islas Malvinas) Gibraltar Montserrat Pitcairn Islands Saint Helena South Georgia and the South Sandwich Islands Turks and Caicos Islands Northern Mariana Islands Puerto Rico American Samoa Wake Island Guam U.S. Virgin Islands Hong Kong Macau Faroe Islands Greenland French Guiana Martinique Reunion Aland Aruba Netherlands Antilles Svalbard Ascension Tristan da Cunha British Antarctic Territory Kosovo Palestinian Territories - West Bank Western Sahara The country of your Citizenship. Your Personal Profile Age * years old. Residence * --- Select Country --- Canada Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Coral Sea Islands Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Cape Verde Central African Republic Chad Chile China Colombia Comoros Congo-Kinshasa Congo-Brazzaville Costa Rica Cote d Ivoire (Ivory Coast) Croatia Cuba Northern Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia South Ossetia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea (North) Korea (South) Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Pridnestrovie (Transnistria) Monaco Mongolia Montenegro Morocco Mozambique Myanmar (Burma) Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somaliland South Africa Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Tajikistan Tanzania Thailand Timor-Leste (East Timor) Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Viet Nam Yemen Zambia Zimbabwe ----------------- Taiwan Christmas Island Cocos (Keeling) Islands Heard Island and McDonald Islands Norfolk Island New Caledonia Clipperton Island Mayotte Guadeloupe Saint Pierre and Miquelon Wallis and Futuna French Southern and Antarctic Lands Bouvet Island Cook Islands Niue Tokelau Guernsey Isle of Man Jersey Anguilla Bermuda British Indian Ocean Territory British Sovereign Base Are British Virgin Islands Cayman Islands Falkland Islands (Islas Malvinas) Gibraltar Montserrat Pitcairn Islands Saint Helena South Georgia and the South Sandwich Islands Turks and Caicos Islands Northern Mariana Islands Puerto Rico American Samoa Wake Island Guam U.S. Virgin Islands Hong Kong Macau Faroe Islands Greenland French Guiana Martinique Reunion Aland Aruba Netherlands Antilles Svalbard Ascension Tristan da Cunha British Antarctic Territory Kosovo Palestinian Territories - West Bank Western Sahara The country where you currently live. Your Personal Net Worth Your Personal Net Worth is the current value of all the assets (e.g. properties, investments, stocks, bonds, bank accounts) that you (and your spouse/common-law partner, if applicable) personally own, MINUS the current value of all your combined personal liabilities (e.g. mortgages, loans, credit card balances). Please be sure to include your share of the value of any businesses that you own. Choose Currency * CAD - Canada, Dollars USD - United States of America, Dollars EUR - Euro Member Countries, Euro AED - United Arab Emirates, Dirhams AFN - Afghanistan, Afghanis ALL - Albania, Leke AMD - Armenia, Drams ANG - Netherlands Antilles, Guilders (also called Florins) AOA - Angola, Kwanza ARS - Argentina, Pesos AUD - Australia, Dollars AWG - Aruba, Guilders (also called Florins) AZN - Azerbaijan, New Manats BAM - Bosnia and Herzegovina, Convertible Marka BBD - Barbados, Dollars BDT - Bangladesh, Taka BGN - Bulgaria, Leva BHD - Bahrain, Dinars BIF - Burundi, Francs BMD - Bermuda, Dollars BND - Brunei Darussalam, Dollars BOB - Bolivia, Bolivianos BRL - Brazil, Brazil Real BSD - Bahamas, Dollars BTN - Bhutan, Ngultrum BWP - Botswana, Pulas BYR - Belarus, Rubles BZD - Belize, Dollars CDF - Congo/Kinshasa, Congolese Francs CHF - Switzerland, Francs CLP - Chile, Pesos CNY - China, Yuan Renminbi COP - Colombia, Pesos CRC - Costa Rica, Colones CUC - Cuba Convertible Pesos CUP - Cuba, Pesos CVE - Cape Verde, Escudos CZK - Czech Republic, Koruny DJF - Djibouti, Francs DKK - Denmark, Kroner DOP - Dominican Republic, Pesos DZD - Algeria, Algeria Dinars EEK - Estonia, Krooni EGP - Egypt, Pounds ERN - Eritrea, Nakfa ETB - Ethiopia, Birr FJD - Fiji, Dollars FKP - Falkland Islands (Malvinas), Pounds GBP - United Kingdom, Pounds GEL - Georgia, Lari GGP - Guernsey, Pounds GHS - Ghana, Cedis GIP - Gibraltar, Pounds GMD - Gambia, Dalasi GNF - Guinea, Francs GTQ - Guatemala, Quetzales GYD - Guyana, Dollars HKD - Hong Kong, Dollars HNL - Honduras, Lempiras HRK - Croatia, Kuna HTG - Haiti, Gourdes HUF - Hungary, Forint IDR - Indonesia, Rupiahs ILS - Israel, New Shekels IMP - Isle of Man, Pounds INR - India, Rupees IQD - Iraq, Dinars IRR - Iran, Rials ISK - Iceland, Kronur JEP - Jersey, Pounds JMD - Jamaica, Dollars JOD - Jordan, Dinars JPY - Japan, Yen KES - Kenya, Shillings KGS - Kyrgyzstan, Soms KHR - Cambodia, Riels KMF - Comoros, Francs KPW - Korea (North), Won KRW - Korea (South), Won KWD - Kuwait, Dinars KYD - Cayman Islands, Dollars KZT - Kazakhstan, Tenge LAK - Laos, Kips LBP - Lebanon, Pounds LKR - Sri Lanka, Rupees LRD - Liberia, Dollars LSL - Lesotho, Maloti LTL - Lithuania, Litai LVL - Latvia, Lati LYD - Libya, Dinars MAD - Morocco, Dirhams MDL - Moldova, Lei MGA - Madagascar, Ariary MKD - Macedonia, Denars MMK - Myanmar (Burma), Kyats MNT - Mongolia, Tugriks MOP - Macau, Patacas MRO - Mauritania, Ouguiyas MUR - Mauritius, Rupees MVR - Maldives (Maldive Islands), Rufiyaa MWK - Malawi, Kwachas MXN - Mexico, Pesos MYR - Malaysia, Ringgits MZN - Mozambique, Meticais NAD - Namibia, Dollars NGN - Nigeria, Nairas NIO - Nicaragua, Cordobas NOK - Norway, Krone NPR - Nepal, Nepal Rupees NZD - New Zealand, Dollars OMR - Oman, Rials PAB - Panama, Balboa PEN - Peru, Nuevos Soles PGK - Papua New Guinea, Kina PHP - Philippines, Pesos PKR - Pakistan, Rupees PLN - Poland, Zlotych PYG - Paraguay, Guarani QAR - Qatar, Rials RON - Romania, New Lei RSD - Serbia, Dinars RUB - Russia, Rubles RWF - Rwanda, Rwanda Francs SAR - Saudi Arabia, Riyals SBD - Solomon Islands, Dollars SCR - Seychelles, Rupees SDG - Sudan, Pounds SEK - Sweden, Kronor SGD - Singapore, Dollars SHP - Saint Helena, Pounds SLL - Sierra Leone, Leones SOS - Somalia, Shillings SPL - Seborga, Luigini SRD - Suriname, Dollars STD - Sao Tome and Principe, Dobras SVC - El Salvador, Colones SYP - Syria, Pounds SZL - Swaziland, Emalangeni THB - Thailand, Baht TJS - Tajikistan, Somoni TMM - Turkmenistan, Manats TMT - undefined TND - Tunisia, Dinars TOP - Tonga, Paanga TRY - Turkey, New Lira TTD - Trinidad and Tobago, Dollars TVD - Tuvalu, Tuvalu Dollars TWD - Taiwan, New Dollars TZS - Tanzania, Shillings UAH - Ukraine, Hryvnia UGX - Uganda, Shillings UYU - Uruguay, Pesos UZS - Uzbekistan, Sums VEB - Venezuela, Bolivares (expires 2008-Jun-30) VEF - Venezuela, Bolivares Fuertes VND - Viet Nam, Dong VUV - Vanuatu, Vatu WST - Samoa, Tala XAF - Communaute Financiere Africaine BEAC, Francs XCD - East Caribbean Dollars XOF - Communaute Financiere Africaine BCEAO, Francs XPF - Comptoirs Francais du Pacifique Francs YER - Yemen, Rials ZAR - South Africa, Rand ZMK - Zambia, Kwacha ZMW - undefined ZWD - Zimbabwe, Zimbabwe Dollars Net Worth * Please select less than CAD 10,000 more than CAD 10,000 but less than CAD 25,000 more than CAD 25,000 but less than CAD 100,000 more than CAD 100,000 but less than CAD 500,000 more than CAD 500,000 but less than CAD 1,000,000 more than CAD 1,000,000 but less than CAD 1,600,000 more than CAD 1,600,000 Your Management Experience ? Management Experience is defined as the performance of duties relating to planning, organizing, and directing financial, human, or material resources. Your Management Experience may have been gained in a private or public business, international agency, government or government department, professional practice, or farming. During any two of the last five years: Do you have management experience? Yes No Have you owned a business? Yes No For the business you most recently owned, please provide the following information. Ownership Percentage % Number of Employees ---Please select--- less than 2 full-time employees 2 or more full-time employees Choose Currency ---Please select--- CAD USD Canada, Dollars Annual Sales Annual Net Profit after Tax Net Worth of Company Did you own and manage any other business(es) during the last five years? Yes No Questions and Comments ? You may list any specific questions or concerns here. If you wish, you can also paste your resume/CV here. Please use this space to send any specific questions, comments or additional information that may be relevant to your inquiry. Submit Form Read in: English
