B.O.O.S.T.

REGISTRATION FORM FOR STUDENTS/TEACHERS/INDUSTRY

Please complete the correct section that applies to you and send via email to: marie_rizzoltc@yahoo.ca

Part A: (For companies only)

Contact Person: _____________________________________________________________________________________________________________

Email: _____________________________ Company Telephone No. ______________________________________________________________

Legal/Corporate Name ____________________________________________________________________________________________________________

GST/COMPANY REGISTRATION # __________________________________________________________________________________________________

Web Site Where You Perform These Services (if applicable): _______________________________________________________________________

Do you have any testimonials/references you can provide by someone who has recently received your product/service?

_______________________________________________________ __________________________________________________________________________

State how the above benefitted from your product/service: _____________________________________________________________________

___________________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________________Would you be interested in adding your name/company in our company's listing? If yes, how do you wish for us to add your name/listing? (maximum 50 characters) ________________________________________________________________________________________

NSAIC Code for what you are bartering for (goods/services): ______________________________ (if not known just leave blank)

Bartering Goods/Services you/your company may contribute? __________________________________________________________________________________________________________________________________

Your Estimated Time: ___________________________________ Value of Service: __________ (by the job) _____________ (hourly)

How can we help to fulfill your bartering needs: __________________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________________

Part B: (Teachers) First and Last Name: _________________________________________________________________________________________

Email Address: ___________________________________ Telephone: ______________________________ Are you a retired/active teacher? ____________________________________________________________ What courses do/did you teach?

_____________________________________________________________ Grade/Level Taught? ______________ _

Qualifications: ______________________ Years Taught _______ Special mentoring/sharing of on resources/lesson plans/strategies of teaching you need/are interested in bartering? Please specify _____________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Do you have a portfolio? Yes ________ No _________ Would you be interested in creating one? Yes/No _________________

Part C: (For Enrolled Post Secondary/Recent Graduate Students)

Name (First and Last) ____________________________________________________________________________________

Email: ___________________________________________________

Indicate which: Program you are currently in? Year?

Undergrad: _____ _______________________________________________________________________ _____

PostGrad: _____ _______________________________________________________________________ _____

9 - 12: _____ __________________________________________________ ____________________ _____

What can you contribute to the B.O.O.S.T.© databank? [Experience, talent, special skills learned]

___________________________________________________________________________________________________________________________________

What would goods/services would you be interested in receiving for your contribution? ________________________________________

___________________________________________________________________________________________________________________________________

Note: Once we have found your match, a $100/year fee applies to companies and $75 teachers/year. A transaction fee of 6% will apply per barter exchange. In cases where students are using B.O.O.S.T.© for the purpose of a placement in their field of study, etc. a 10% placement fee applies which will be charged to the employer. Please print the form and email with your signature here: _______________________________

How do you wish to pay for services rendered?

Credit Card (Check one)

Visa ___

MasterCard ___

Discover ___

American Express ___

Bank Debit ____

Cash ____

Do you have a learning portfolio that employers can see? Yes ________ No ________

By signing below, you agree that you have read the terms and conditions of agreement on the B.O.O.S.T.© site, agree to the transaction and registration fees applicable, and understand that a bartering fee will be charged as per transaction.

______________________________ ______________ _______________________________________________

Name of Applicant (Please Print) Title Signature

______________________________ ______________ ______________________________________________

Name of Company Providing Barter Title Signature

________________________________________________________________ ___________________________

Authorized B.O.O.S.T.© Signature Dated