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Key Executive Nomination
The following survey consists of 10 short questions and takes approximately 5 minutes to complete.
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1.
Nominee's Name
(Required.)
2.
Nominee's State (NY, CA, TX, etc. ) or if in Major Metro Area (i.e. NYC, LA, Dallas, DC, etc.)
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3.
Nominee's Company
(Required.)
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4.
Nominee's Position at Company
(Required.)
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5.
Nominee's Sector
(Required.)
Software
Healthcare Technology
Financial Technology
Consumer Technology
Media
Other (please specify)