Special Patronage Point – Registration & Biodata Form
Special Patronage Point – Registration Form Instructions
If you are submitting this form for the Special Priority Access Patronage Point, please follow these steps:
Step 1: Download and Print
- Download this form.
- Print it out, or copy it by hand.
Step 2: Fill It Out Completely
- Provide all the information requested.
- Do not leave any required fields blank.
Step 3: Contact Us First
- Before mailing your form, contact us to let us know you have a completed form ready to submit.
- We will then send you:
- A private email address for notification
- A physical mailing address to send your form
Step 4: Mail Your Form
- Send your completed form to the physical mailing address we provide.
- Do not send your filled-out form by email.
Step 5: Receive Your ID Number
- Once we receive and process your form, we will issue your ID number.
- You can then begin collecting your Special Priority Access Patronage Points.
Important Notes
- Email is only for notification. Use email only to tell us you have mailed your form, or to ask questions about your biodata form.
- Your information is kept private. We store all biodata forms manually in our private database to protect your valuable information.
- You can submit your form anytime within the year. However, to collect the Special Priority Access Patronage Point, you must receive your ID number before June 2027.
Ready to Begin?
- Download the form from this page.
- Fill it out completely.
- Contact us to let us know your form is ready.
- Mail it to the address we provide.
- Receive your ID number and start collecting your Special Patronage Points.
Become one of the first 100,000 Founding Members of the Essentials Economy.
Together, we are building an economy that belongs to everyone.
Section 1: Personal Information
| Field | Your Response |
|---|---|
| Full Legal Name | |
| Preferred Name | |
| Date of Birth | |
| Gender | ☐ Male ☐ Female ☐ Prefer not to say |
| Nationality | |
| Country of Residence | |
| City / Town | |
| Email Address | |
| Phone Number | |
| Secondary Phone (optional) | |
| Preferred Language(s) |
Section 2: Identification
| Field | Your Response |
|---|---|
| Government-Issued ID Type | ☐ Passport ☐ Driver’s License ☐ National ID ☐ Other: _______ |
| ID Number | |
| ID Expiry Date |
(Note: This information is for verification purposes only and will be kept strictly confidential.)
Section 3: Emergency Contact
| Field | Your Response |
|---|---|
| Contact Name | |
| Relationship | |
| Phone Number | |
| Email Address |
Section 4: Skills & Expertise
Please tell us about your professional background and skills. This helps us match you with opportunities in the Essentials Economy.
| Field | Your Response |
|---|---|
| Highest Education Level | ☐ High School ☐ College Diploma ☐ Bachelor’s Degree ☐ Master’s Degree ☐ Doctorate ☐ Trade Certification ☐ Other: _______ |
| Field of Study / Specialization | |
| Current Occupation | |
| Years of Experience in Your Field | |
| Key Skills (List up to 5) | 1. 2. 3. 4. 5. |
| Technical Skills (e.g., IT, engineering, accounting) | |
| Soft Skills (e.g., leadership, communication, teaching) | |
| Languages Spoken (with proficiency level) |
Section 5: Business & Entrepreneurship Experience
| Field | Your Response |
|---|---|
| Have you ever owned or managed a business? | ☐ Yes ☐ No |
| If yes, please describe: | |
| Industry / Sector | |
| Years of Operation | |
| Have you ever worked in a cooperative? | ☐ Yes ☐ No |
| If yes, please describe your role: |
Section 6: Interest in the Essentials Economy
| Field | Your Response |
|---|---|
| How did you hear about the Essentials Economy? | |
| Why are you interested in joining? | |
| What role would you like to play in the new economy? | ☐ Investor ☐ Business Founder ☐ Manager ☐ Worker ☐ Volunteer ☐ Supporter ☐ Other: _______ |
| Which sector interests you most? | ☐ Food & Grocery ☐ Housing ☐ Transportation ☐ Insurance ☐ Technology ☐ Education ☐ Healthcare ☐ Other: _______ |
| Are you willing to relocate for opportunities? | ☐ Yes ☐ No ☐ Maybe |
Section 7: Patronage Point Commitment
Please select your preferred contribution method for the Special Priority Access Patronage Point.
| Option | Selection |
|---|---|
| Option A: Monthly Contribution | ☐ I commit to $50 CAD per month for 12 months (June 2026 – June 2027) |
| Option B: One-Time Contribution | ☐ I commit to $600 CAD in one payment |
Payment Method Preference:
☐ Bank Transfer ☐ Credit Card ☐ PayPal ☐ E-Transfer ☐ Other: _______
Section 8: Additional Information
| Field | Your Response |
|---|---|
| Do you have any physical or health limitations we should be aware of? | |
| Do you have any specific needs or accommodations? | |
| Is there anything else you would like us to know about you? |
Section 9: Declaration & Consent
By signing below, I confirm that:
- The information provided in this form is accurate and complete.
- I understand that the Special Priority Access Patronage Point is a limited-time opportunity available only until June 2027.
- I understand that the Essentials Economy is a cooperative platform, and my participation is voluntary.
- I consent to the storage and use of my information for the purposes of the Essentials Economy platform.
- I understand that my skills and expertise may be considered for future opportunities within the new economy.
| Field | Your Response |
|---|---|
| Signature | |
| Date |
Section 10: For Office Use Only
| Field | Office Use |
|---|---|
| Registration Number | |
| Date Received | |
| Verified By | |
| Special Points Allocated | |
| Notes |
How to Submit This Form
- Online: Visit https://myeec.ca/contact Let us know you have a completed form.
- Email: Send a scanned copy to [ provided email address].
- Mail: Also send to [provided mailing address].
Thank you for becoming a Founding Member of the Essentials Economy.
Together, we are building an economy that belongs to everyone.