Organization

 Title

 Address

 City

 State

 Phone

 Fax

 E-mail

My organization is an:

association
corporation
other (please describe)

My organization is currently:

self managed
with a management company
contracting brokered services
other

My organization's focus area is:

medical/healthcare
trade group
commercial
other (please describe)

My organization's size is:

Less than 1,000
1,001 to 5,000
5,001 to 10,000
More than 10,000

My organization's membership is:

International
National
Regional
State
Local

My organization's annual budget is:

less than $250,000
$250,000 – $500,000
$500,000 – $1 M
$1 – $3 M
$3 – $5 M
more than $5 M

My organization was established in the year

Are you preparing a
request for proposal (RFP) --- Yes No

Please contact me via Phone Fax E-mail