Application Form

    Business Information

    Contact Information


    Additional Information

    On behalf of the business identified above, I hereby submit the application for the Virtual Adviser Program. I certify that I am an authorized officer of the business and that the information provided in this application and its attachments is true and correct to the best of my knowledge and belief. I agree to comply with the program requirements, including reporting requirements. 

    I acknowledge and agree to allow the Cumberland Business Connector, BoomersPlus or a designate to make any inquiries of such persons, firms, corporations, and federal and provincial government agencies/departments required to collect and to share information with them, including personal information as defined in the Freedom of Information and Protection of Privacy Act, as the Cumberland Business Connector deems necessary, in order to reach a decision on this application; to administer and monitor the implementation of the Virtual Adviser program; and to evaluate the results of this program after project completion. I hereby waive confidentiality of such information and agree that its collection and disclosure will not be the basis of any liability, claim or order against the Cumberland Business Connector. 

    By signing below, you consent to the Cumberland Business Connector releasing your contact and application information to BoomersPlus or any third-party service providers retained for the purposes of delivering and evaluating the program. This consent is valid whether your application is successful or not. You agree to being contacted by BoomersPlus or any such third-party service providers and will cooperate with them in the collection of information required for the delivery and the evaluation of the program. You further agree to release the Cumberland Business Connector, BoomersPlus and their respective staff, Advisers, and third party service providers from any claims, causes of action, suits, actions and liabilities of every nature and kind whatsoever arising from, as a result of or in any way related to the aforementioned authorized release of contact information and subsequent collection and use of information. If you do not consent to the disclosure of your contact information, you cannot participate in the Virtual Adviser Program.
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