Membership Registration Form There would be three levels of Membership in the UcanMAP network. Students wanting to engage in dialogue about creating change and seek avenues for interviews are welcome to join as “future innovators”. Professionals already innovating in the economic, social or political arenas through social entrepreneurship and those seeking to join their ranks are invited to join as “innovators”. Membership is also open to organizations and individuals who are willing to provide various forms of support—funding, capacity building, business advice,etc—as “innovating partners”. Innovator Future Innovator Innovating Partner Membership Type Required Mr. Mrs. Ms. Rev. Dr. Prof. Other Title Last Name* First Name* Street Address 1 Street Address 2 Town or City State Zip or Post Code Telephone (Optional) Career or Profession E-Mail* Confirm E-Mail* How did you find UCanMap? Please Select One ----> AltaVista America Online AOLFind Ask Jeeves Excite Google Go Goto Hotbot Infoseek Lycos MSN Northern Lights Snap Web Crawler Yahoo Banner Ad Friend Website News Group Magazine/Newspaper Radio Other Comments/Questions: ********* Fields in asteriks (*) are required. *********