Event Registration
N/A
Title of Event: N/A
Event Location: N/A
Event Address: N/A
Event City: N/A
Date of Event: December 31, 1969
Start Time of Event: 6:00 pm
End Time of Event: 6:00 pm
 
  * Green Fields are required
Company Name:
Attendee Name:
Physical Address:
City:
State:
Zip:
County:
Same as Physical Address:
Mailing Address:
City:
State:
Zip:
County:
Work Phone:
Fax:
Cell Phone or Pager:
E-Mail Address:
URL/Web Address:
Attendee Type:
 
If this is your company's first time to contact the N/A,
please complete the following:
Avg # of Employees (last 3 yrs):
Avg Yearly Gross Sales (last 3 yrs):
Date Business Was Established:    [YYYY-MM-DD or MM/DD/YY]
Have you previously done business with any government agency or prime contractor?
Yes No Don't Know
 
Business Ownership:
Check all that apply. (Defined as 51% owned and controlled.)
Woman-owned Minority-owned Veteran-owned
Service Disabled Veteran-owned
Business Certifications and Determinations:
Check all that apply.
Disadvantaged Business
Distressed
Certified HUBZone
Small Business
 
Generally describe or list the products or services you wish to offer to the government:
List the types of services you might want to receive from our center:
How did you hear about us?
    Other:

By submitting this registration I give consent to N/A to provide my company with PTAC client services.