| Ms. Mr. Mrs. |
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| * Name |
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| Title |
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| Company |
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| * Address |
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| * City |
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| * Province |
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| * Postal Code |
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| * Telephone |
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| Fax |
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| * E-mail |
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| Education: (degrees, professional designations) |
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| Name and title of person to whom you report |
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| Number of years in investor relations |
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| Brief description of your investor relations responsibilities/activities |
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Listed Company Information
(complete this section only if you are employed at a company whose securities are listed for trading) Industry Sector |
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None |
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Biotechnology and Pharmaceuticals |
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Communications and Media |
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Conglomerates |
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Consumer Products (Food Processing, Tobacco, Distilleries, Breweries, Beverages, Household Goods, Auto /Parts, Packaging) |
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Financial Services (Banks, Trust, Savings & Loan, Investment Companies & Funds, Insurance, Financial Management Companies) |
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Industrial Products (Steel, Fabricating, Engineering, Transportation Equipment, Technology, Computer, Cement/Concrete Products, Chemicals, Business Services) |
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Merchandising (Wholesale Distributors, Food and Merchandise Stores, Hospitality) |
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Mining (Base and Precious Metals) |
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Oil & Gas |
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Paper & Forest Products |
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Pipelines |
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Real Estate and Construction |
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Transportation and Environmental Services |
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Utilities |
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Other |
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| Exchange Listing |
| Stock Symbol |
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| Canadian Exchanges |
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| U.S. Exchanges |
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| Other Exchanges |
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| Market Capitalization |
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| Membership Category Selection (all applicants to complete) |
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By submitting this membership application to CIRI, the applicant agrees to abide by CIRI's bylaws.
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| I consent to the collection, use and disclosure of my personal information during the course of my membership for the purposes set out in the CIRI members' Privacy Policy, which is available on www.ciri.org. I further consent to my contact information being published in web or print directories produced by CIRI and/or its chapters. |
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