XCELERATE Partner Registration Form

13 March,2010

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Key Contact's details (details of the person who we should contact about this partner application)
Your name
Company name
Address
Email
Phone
Applicant's Details (details of the person or company applying to become a partner)
Applicant name
Applicant email
Applicant Website
Prospective Business Information (information about the potential business the applicant will bring as a partner)
Type of applicant
Size of potential market (annual AU$value)
Size of potential market (number of prospects)
Prospects' operating industries	Industry "Ctrl-Click" Selects Multiple
Where did you find out about XCELERATE?
Form Submission By submitting this form, you acknowledge and represent to Business Continuity Asia Pacific that you have read and accept the terms and conditions of the XCELERATE program and that you, the person filling out this form, has authority to bind the person named as applicant in this form to such terms and conditions.
I accept the terms and conditions for and on behalf of the person named as applicant.

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