First step -Organization listing

First step

Organization listing

Hello,

Thank you for your interest in partnering with the Centre hospitalier de l'Université de Montréal (CHUM).

Before submitting your collaborative project proposal, we ask you to complete this initial form. Once submitted, you will receive an e-mail indicating the unique identifier assigned to your organization (e.g. PAR0123), which you can use each time you wish to submit a collaborative proposal to CHUM, via the second form.

Thank you in advance, and we look forward to hearing from you!

Please note that any information shared via this form must be of non-confidential nature.

Information on your organization

Organization name*

Organization type*

Sélectionner

Please specify the type of organization*

Headquarters location of the organization*

Québec

Canada (autre que Québec/ outside Québec)

International

Please specify location (city, region, country)*

Do you have offices in Quebec?*

Oui / Yes

Non / Non

Number of employees in Quebec?

Organization sector*

Sélectionner ou saisir une valeur

Please specify sector*

Organization website

If existing

Have you ever been in contact with the CHUM or CRCHUM?*

Oui / Yes

Non / No

If yes, in what context?*

Supplier, research project...

Main contact

Title*

Sélectionner

Last name*

First name*

Position/title in the organization*

e-mail*

Phone number

Phone

No legal proceedings

I declare that my organization and all of its representatives (including, but not limited to, employees or consultants, or if applicable, subcontractors) have not been and are not being the subject of a legal proceeding in connection with their professional activities.*

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