First
Name:
Last
Name:
Business E-Mail
Address: **
Company:
Address:
Number of Employees:
- select from list -
0 - 10
10 - 30
30 - 50
50 - 100
101 - 500
501 - 1000
1001 - 2000
2001 +
City:
State/Province:
Alabama Alaska Alberta Arizona Arkansas British
Columbia California Colorado Connecticut Delaware District
of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New
Brunswick New Hampshire New
Jersey New Mexico New York Newfoundland North Carolina North Dakota Northwest Territories Not Applicable Not Selected Nova Scotia Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Province of Quebec Puerto Rico Rhode Island Saskatchewan South
Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon
Territories
Zip/Postal Code:
Country:
Afghanistan Albania Algeria Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaidjan Bahamas Bahrain Bangladesh Barbados Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia-Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Byelorussia Cambodia Cameroon Canada Cape
Verde Cayman Islands Central African
Republic Chad Chile China Cocos (Keeling) Islands Colombia Comoros Congo Congo, Democratic Republic (Zaire) Cook
Islands Costa Rica Croatia
(Hrvatska) Cuba Cyprus Czech Republic Czechoslovakia Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Great
Britain Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea
Bissau Guyana Haiti Heard and McDonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Ivory Coast (Cote D'Ivoire) Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kitts and
Nevis Korea (Republic of) Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall
Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldavia Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Antilles Netherlands/Holland New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Not Applicable Not Selected Oman Pakistan Palau Panama Papua-New Guinea Paraguay Peru Philippines Pitcairn Island Poland Portugal Puerto
Rico Qatar Reunion Romania Russia Rwanda S. Georgia & S. Sandwich Isls. Saint
Lucia Samoa San Marino Sao Tome and Principe Saudi Arabia Scotland Senegal Seychelles Sierra Leone Singapore Slovak Republic Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka St.
Helena St. Pierre and Miquelon St.
Vincent & Grenadines Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Unknown Uruguay USSR Uzbekistan Vanuatu Vatican City State Venezuela Vietnam Virgin
Islands Virgin Islands (British) Wales Wallis and Futuna Islands Western Sahara Yemen Yugoslavia Zaire Zambia Zimbabwe
Phone:
(example: 602-968-2818)
Fax:
(example: 602-968-2818)
Primary Business/Industry:
Aerospace and Defence
Accountant - Financial Services
Choose One
Contracting - Construction
Contracting - Services
Distributor/Dealer of Equipment or Supplies
Engineering/Consulting/Planning
Government
Industrial Systems
Manufacturer of Equipment or Supplies
Oil and Gas
Other
Outside Maintenance Services
Outside Operational Services
Pharmaceutical
Software Development
Telecom
Utilities
Position:
Choose One
Asset Portfolio Management Analyst
Assistant Manager
Bid & Proposal Engineer Bid & Proposal Manager Bid & Proposal Professional
Business
Development Manager Civil Engineer Computer Systems Analyst
Construction Engineer Consulting
Engineer Corporate
Comptroller Customer Service Director of Customer Service & Logistics Director of Market Development Director of
Product Development Director of Public Works
Division Operations
Manager Division SalesManager E-Business E-Business Manager
Electrical Engineer Engineer Engineering Engineering Management
Field Engineer Industrial Engineer Information Systems/Technology Maintenance Manager Manager Managing Director Marketing/Sales
Manager Mechanical Engineer MIS Management
National Sales Manager Operations Manager
Other Outside Sales Rep.
Plant
Manager President, Vice
President Principal Engineer Principal Software Engineer
Product Development Engineer Product Engineering Manager Production Technician Programmer Project Designer Project Engineer Project Manager Project/Client Services
Manager Public Works Director Purchasing Management Quality Assurance Manager Quality
Control/Quality Assurance Engineer Quality Engineering
Manager Regional Sales
Manager Research
Director Sales Sales Engineer Sales Representative Senior Production Planner Senior Project
Engineer Software Development Engineer Software Engineer Sr. Project Manager Sr. Software Engineer Structural Engineer Sup
Civil Eng Systems Engineer
Technical Sales Representative Territory Manager Territory Technical
Marketing Managers Training
Management VP Sales & Marketing
Job Function:
Academia
Analyst
Choose One
Consulting
Corporate Management
Engineering
Government
Health/Safety/Security
Human Resources
Management
Not Specified
Operations
Other
Purchasing
Research & Development
Sales
Sales & Marketing
Technical
Annual Revenue (USD):
Choose One
<1 Million
1-5 Million
5-10 Million
10-50 Million
50-100 Million
100-250 Million
250-500 Million
>500 Million
Web
Site:
Specific coments or questions: (max 250 characters)
Interest: (check all that apply)
Product Catalog Management
Proposal Generation
Proposal Management
Sourcing & Procurement