ONLINE APPLICATION

Please complete the application now to qualify for the Midsize Enterprise Summit in the region nearest you. Attendance is limited to 400 Senior IT Executives per event.

You will be contacted in May regarding your application to attend.

* Required Information
* Please select the Event that you are geographically closest to.
Spring Summit
       May 3-6, 2009
       Miami, FL		 Fall Summit
       Sept 13-17, 2009
       Los Angeles, CA
* Are you new to the Midsize Enterprise Summit?
Yes, I am new     No
Salutation Mr.    Ms.    Dr.
First Name*
Last Name*
Title*
Organization*
Street Address*
City*
State*
Zip*
Telephone*
Fax
E-mail Address*
Web site*

Please take a few minutes to answer the following questions so we can better serve you:

1. How did you learn about Midsize Enterprise Summit?
Mailing
Enter priority code 		CIO Association of Canada
        
E-mail
Enter priority code 		Society for Information Management (SIM)
        
Colleague/Peer Reference
Please provide name 		Illinois CIO Exchange (ICE)
        
CIO Magazine Advertisment Chamber of Commerce/User Group
Please provide name of organization
Phone Print or Electronic Media (Newsletter/Magazine)
Gartner Resource? Browsing the Web
Everything Channel Resource? Other Vision Event(s)?
Other:

2. What best describes your organization's primary industry?

Other

3. What best describes your job function?

Other

4. Who do you directly report to within your organization?

Other

5. How many people are employed in your entire organization?
1-99 1,000-2,499
100-249 2,500-4,999
250-499 5,000-9,999
500-999 More than 10,000

6. How many people are employed in your IT Department?
1-5 21-50
6-10 50-100
11-20 100+

7. What is the total number of enterprise seats in your organization?
1-49 500-999
50-99 1,000-1,499
100-249 1,500-2,499
250-499 More than 2,500

8. How many of your work force are mobile/remote users?
1-49 500-999
50-99 1,000-1,499
100-249 1,500-2,499
250-499 More than 2,500

9. What is your organization's total annual revenue?
Less than $50 million $500 million - $749 million
$50 million - $99 million $750 million - $1 billion
$100 million - $249 million More than $1 billion
$250 million - $499 million  

10. What is your organizations annual IT budget, excluding payroll?
Less than $1 million $50 million - $100 million
$1 million - $5 million $100 million - $500 million
$5 million - $10 million More than $500 million
$10 million - $50 million  

11. What is your role in IT purchase decisions?
Final Decision-Maker
Decision Influencer
Recommend Products/Services

12a. Do you purchase through a solution provider (VAR)?
Yes
No

12b. If Yes, Who?

 
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Thank you for your interest in the Midsize Enterprise Summit!