First Name*
 
 
Last Name*
 
 
 
Email Address*
 
 
 
Telephone
 
 
 
Company / Organization
 
 
 
Where do you reside? (City)*
 
 
 
Where do you reside? (Country)*
 
 
 
What is your connection to Manitoba?*
 
 
 
Why is helping Manitoba companies find connections important to you?*
 
 
 
Are you committed to supporting the Club through identifying potential connections?*