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Partners in Learning

Serious Games Summit - October 30-31
Partnering Forum - November 1-2

COMPANY PROFILE AND REGISTRATION FORM

Partners in Learning is a Business Development initiative designed to help Canadian technology companies develop partnerships with key systems integrators in the U.S. mid-Atlantic market. This program is sponsored by Foreign Affairs and International Trade Canada, and by Industry Canada.

Please note: this form will only submit electronically through Internet Explorer from a PC. If you are using another browser, such as Firefox, or a Mac computer, you will need to download and print the form then, fax it to (202) 682-7619.

*Required Fields

Company Information

*Company Name:
Address:
*Telephone:
Facsimile:
Company Website:
Is your company presently doing business in the U.S.?   Yes    No
Please provide a brief description of your products and services for the Partners in Learning 2006 event directory (250 words or less):

Before continuing, please send a separate e-mail with a copy of your company logo (in JPEG format) to: C.J.Scott@international.gc.ca

Participant Information

*Participant #1 - Name:
*Participant #1 - Title:
*Participant #1 - E-Mail:
Passport information is required for access to some secure site visit locations. If you are not comfortable sending this data via this internet form, please e-mail C.J.Scott@international.gc.ca with your details, and please enter "none" in each of the fields below. If you do not have a passport, or are an American citizen, please enter your Social Insurance (SIN) or Social Security (SSN) number, and one additional type of identification in the boxes below, and enter "none" in those you do not fill in.
*Participant #1 - Passport Number:
*Full Name on Passport:
*Place of Birth:
*Nationality:
*Date of Birth:
*Place of Passport Issue:
*Date of Passport Issue:
Participant #2 - Name:
Participant #2 - Title:
Participant #2 - E-Mail:
Participant #2 - Passport Number:
Full Name on Passport:
Place of Birth:
Nationality:
Date of Birth:
Place of Passport Issue:
Date of Passport Issue:

Program Participation

Which program elements will you be participating in?
The Serious Games Summit

*Registration for a Full Conference pass for the duration of the conference, entitling the participant to:
  • Access to all sessions, lectures, panels, and keynotes;
  • Entrance into the Developer Showcase;
  • Entrance into Monday's Opening Night Reception; and
  • Lunch and refreshments provided during the events.
Reduced rate available for Canadian companies who register through Partners in Learning - US$535.50/per person BEFORE October 2nd.

*Note - if you choose to participate in the Serious Games Summit, you will be contacted by a Canadian industry organization, Alliance NumeriQC to obtain payment and registration details. Alliance NumeriQC is coordinating Canadian participation, at the reduced rate, for the Serious Games Summit.		   Yes    No
The Embassy Partnering Forum

Participation in this Partnering Forum is free for Canadian companies.

Representatives are required to pay for their own travel and accommodation costs. 		  Yes    No

Questions? Phone: (202) 448-6312 or E-Mail: C.J.Scott@international.gc.ca

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