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Student Membership Registration Form

Thank you for your interest in joining the TechAlliance member community. We are thrilled that, as a student, you are taking this step to become active and engaged with the local tech sector. Once you have completed the below registration form one of our staff will be in touch to confirm your membership status.

On behalf of TechAlliance, we would like to thank you for your support and we look forward to working with you in the future.

1. Please complete the below contact information: *This question is required.

First Name *This question is required.

Last Name *This question is required.

Street Address *This question is required.

City *This question is required.

Province *This question is required.

Postal Code *This question is required.

Phone Number *This question is required.

Name of University/College *This question is required.

Student Number *This question is required.

Program *This question is required.

Email *This question is required. This question requires a valid email address.

2. To help us stay better connected please complete the applicable fields:

Please provide in the following format: http://www.twitter.com/xxxxxxxxx

Twitter handle

Please provide in the following format: http://www.linkedin.com/xxxxxxxxx

LinkedIn Profile

3. As a new member you will be signed up to receive TechAlliance's e-newsletter, Tech Times. This correspondence is distributed twice monthly and is the most efficient way to stay on top of programs, news and announcements from TechAlliance. The Tech Times will also keep you in the loop on local member, community and business news. *This question is required.

4. Please tell us why you are interested in being connected to the regional tech community: *This question is required.

5. I grant TechAlliance permission to use images from TechAlliance events in which I appear, for the sole purpose of TechAlliance marketing and promotion, including but not limited to, online/website usage and print materials. *This question is required.

6. Please rank, in order of importance, with 1 being the most important and 5 being the least important, your reasons for becoming a TechAlliance member: *This question is required. Note: for the following table each column is restricted to a single answer across all rows.

	1	2	3	4	5
Education & Professional Development	Rank Education & Professional Development as 1 out of 5	Rank Education & Professional Development as 2 out of 5	Rank Education & Professional Development as 3 out of 5	Rank Education & Professional Development as 4 out of 5	Rank Education & Professional Development as 5 out of 5
Networking opportunities	Rank Networking opportunities as 1 out of 5	Rank Networking opportunities as 2 out of 5	Rank Networking opportunities as 3 out of 5	Rank Networking opportunities as 4 out of 5	Rank Networking opportunities as 5 out of 5
Volunteering opportunities	Rank Volunteering opportunities as 1 out of 5	Rank Volunteering opportunities as 2 out of 5	Rank Volunteering opportunities as 3 out of 5	Rank Volunteering opportunities as 4 out of 5	Rank Volunteering opportunities as 5 out of 5
To meet with potential employers	Rank To meet with potential employers as 1 out of 5	Rank To meet with potential employers as 2 out of 5	Rank To meet with potential employers as 3 out of 5	Rank To meet with potential employers as 4 out of 5	Rank To meet with potential employers as 5 out of 5
Member Rewards program	Rank Member Rewards program as 1 out of 5	Rank Member Rewards program as 2 out of 5	Rank Member Rewards program as 3 out of 5	Rank Member Rewards program as 4 out of 5	Rank Member Rewards program as 5 out of 5

7. How did you hear about TechAlliance's Student Membership?

Please provide details on your answer to the question above.

8. Are you currently starting a technology business and interested in our no-cost business consulting services? If you choose yes, you will be contacted by a Business Services Business Analyst.

Lead Source

Company