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Personal Information
First name:
Last name:
Gender:
Date of Birth:
Marriage Status:
--Select One--
Single, Never married
Married or domestic partner
Widow
Divorced
Separated
Annual household income before taxes:
--Select One--
20,000 – 44,999
45,000 – 69,999
70,000 – 94,999
95,000 – 1,19,999
1,20,000 – 1,44,999
1,50,000 or greater
Total Number of members :
Total Number of children:
Retired person :
Mobile Number:
Email Address:
Street address:
State:
City:
Postal code:
Country :
Educational status
What is the highest degree or level of school you have completed?:
--Select One--
Nursery School to 8th Grade
Some High school
High school graduate
Associate degree
Bachelor’s degree
Master’s degree
Professional degree
Doctorate degree
Professional Details:
Employment status:
--Select One--
Employed for wages
Self employed
Employed full-time
Employed part-time
Contract, Freelancer or Temporary Employee
A homemaker
A student
Military
Retired
Unable to work
Prefer not to say
What is your job title?:
--Select One--
C-level (CEO, CFO, CTO, CIO,CMO)
Owner, Partners
Vice President
Director
Manager
Analyst
Assistant or Associate
Administrative
Consultant
Intern
Volunteer
None of the above
Prefer not to say
What is your company’s primary type of business?:
--Select One--
Agriculture
Aerospace and defence
Automotive
Banking and financial Service
Chemicals
Construction
eCommerce
Education
Energy
Engineering
Entertainment
Government and public sector
Healthcare
Insurance
Life Science
Manufacturing
Mining and Extraction
Non-profit Sector
Publishing and media
Real Estate
Retail and Wholesale Trade
Technology
Telecommunication
Transport
Logistics
Travel and Hospitality
Utilities
Sales
How many employees work at your Organization (all locations)?:
--Select One--
1 TO 49 EMPLOYEES
50 TO 249 EMPLOYEES
250 TO 499 EMPLOYEES
500 TO 999 EMPLOYEES
1000 TO 1999 EMPLOYEES
2000 TO 4999 EMPLOYEES
5000+
What is the annual revenue for your organization?:
--Select One--
UNDER $10000
$10000-$24999
$25000 - $49999
$50000 - $99999
$1MILLION – $4.99MILLION
$5MILLION – $9.99MILLION
$10MILLION - $49.99MILLION
$50MILLION - $99.99MILLION
$100MILLION – 249.99MILLION
$250MILLION – 499.99MILLION
$500MILLION – $999.99MILLION
$1BILLION+
Which departments you work within at your organization:
--Select One--
Administration/General Staff
Customer Service/ Client Service
Executive Leadership
Finance/Accounting
Human Resource
Legal/Law
Marketing
Operations
Procurement
Sales/Business Development
Technology Development Hardware (not for hardware)
Technology Development Software (not for software)
Technology Implementation
Other
I don’t work
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