Washington Technology FREE Subscription Form

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First Name:         Last Name:          Title:              Company Name:       Address1:           Address2:           City:               State:              ZIP Code:           Country:            Office Phone:      (format: 123-456-7890)  Office Fax:        (format: 123-456-7890)  Business E-mail:    

1. Does your company provide systems integration products or services to the following types of business (select all that apply):

	As a:
Provided to :	Prime Contractor	Sub- Contractor	8A/Minority Disadvantaged	Other
1. Federal Government
2. State & Local Government
3. Commercial Business
4. International Business
If Other, please specify:

2. The primary business activity of your organization is (select one only):

Systems Integrators
1. Systems Integration 2. Network Integration 3. VAR -Systems Integration 4. VAR - Vertical Application 5. Systems/Software Development 6. Systems/Software Consultant 7. OEM - Manufacturer Integration 8. Distributor/Aggregator 9. Communications Integration 10. Aerospace/Defense Integration

Government Executive
11. Federal Government Executive 12. State or Local Government Executive

Other Industries
Please Specify:

3. Please indicate your primary job function (select one only):

1. President/CEO 2. Program/Project Management 3. Technical Management 4. General Corporate Management 5. Business Development 6. Marketing Management 7. Sales Management 8. Engineering 9. Systems Analyst 10. Contract Management/Officer 99. Other

If Other, please specify:

4. My computer provides systems integration products or services to: (select all that apply)

Federal Government
State/Local Government
Commercial business
International business

5. Please indicate the products and services which you or your organization resells, specifies, recommends or approves the purchase of (select all that apply):

COMPUTER SYSTEMS

6.Please indicate the value of products and services that you resell, specify, recommend or approve the purchases of (select only one):

$25 million or more Over $10 million to $25 million Over $5 million to $10 million Over $1 million to $5 million Over $500,000 to $1 million Over $100,000 to $500,000 Over $25,000 to $100,000 Under $25,000

7.Please indicate the largest company/federal agency that you automate (select only one):

Over 10,000 employees 5,000 to 9,999 employees 1,000 to 4,999 employees 500 to 999 employees 100 to 499 employees Under 100 employees

8. My organization can purchase off the GSA schedule:

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9. My organization is involved in teaming decisions with other contractors:

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