Please:

Invoice me $1000 for my contribution Contact me about a contribution of my services

Here is my contact information:

Name: 

Title: 

Company: 

Address line 1: 

Address line 2: 

City: 

State/Province: 

Zip/Postal Code: 

Country: 

Telephone: 

Fax: 

E-mail (be sure to include ".com" etc.): 

Other:  Please take a few minutes to complete our questionnaire.

What is your organization's primary business activity at your location?

Choose One: Internet Service Provider Web hosting service Internet/commercial online service Software developer/publisher Internet VAR/VAD/systems integrator Internet/computer consultant Telecommunications Carrier Cable carrier Networking/communications manufacturing Computer/software manufacturer Computer VAR/VAD/systems integrator Cable TV network Broadcast TV/radio Publishing Entertainment Advertising/public relations General manufacturing Non-profit Government Education Finance/banking/accounting Insurance/legal services/real estate Health care Wholesale/retail trades Transportation Utilities/petroleum/gas Architecture/engineering/construction Hospitality/travel Agriculture/forestry/fisheries Consultant (non-Internet/computer)

In which ways are you involved in Internet/Intranet management or development at your organizaiton?

Choose One: Senior/executive management Manage finances Manage content/application development Manage strategic relationships Manage strategic planning and staff Manage public policy/legal issues Manage interactive marketing/promotion Other None

What are the total annual revenues of your entire organization?

Choose One: Over $10 billiion $1 billion to $9.9 billion $500 million to $999 million $100 million to $499 million $50 million to $99 million $25 million to $49 million $5 million to $24 million $1 million to $4 million $500,000 to $999,999 Under $500,000