Confidential NECA Peer Group Interest Form & Company Profile

All interest forms and company profile information be kept entirely confidential. The purpose of this survey is to connect NECA members with a facilitator that will provide the greatest potential fit. Completion of this form does not obligate joining a Peer Group.

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* 1. Please fill out the information below:

Name:

Title:

Company Name:

NECA ID :

NECA Chapter:

City, State, Zip Code:

Email Address:

Phone:

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* 2. What is your most recent annual sales volume?

$0-$10M

$10M - $25M

$25M-$50M

$50M +

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* 3. Please list your home office location(s), branch locations (if applicable), and typical geographical area.

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* 4. A typical peer group with a third party facilitator will require an financial investment of close to $10,000 annually for facilitator costs and potential travel for peer group meetings. Are you willing to commit to this financial structure?

Yes

No