Organization*
 
 
 
First Name*
 
 
Last Name*
 
 
 
City*
 
 
Province*
 
 
 
Phone*
 
 
Email Address*
 
 
 
Primary industry*
 
 
# of Employees*
 
 
 
# of Years in Business*
 
 
 
Avg. Revenue (Last 3 Years)*
 
 
 
What is the purpose of your business and how does it support your community? Please include links, if relevant. (750 words max)*
 
 
 
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