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. Please direct any specific questions to Ian Andrews, Field Representative, ian.andrews@necanet.org.

Question Title

* 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. What price range are you comfortable investing annually to be a part of a peer group? (check all that apply)

Up to $5,000

$5,000 - $10,000

$10,000-$15,000

$15,000-$20,000

$20,000 +

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* 5. How soon do you wish to join a Peer Group?

As soon as possible

Within the next six months

Within the next year

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* 6. A typical peer group meets at least twice annually at locations to be determined across the country. Are you willing to commit to this level of participation?

Confidential NECA Peer Group Interest Form & Company Profile

Question Title

* 1. Please fill out the information below:

Question Title

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

Question Title

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

Question Title

* 4. What price range are you comfortable investing annually to be a part of a peer group? (check all that apply)

Question Title

* 5. How soon do you wish to join a Peer Group?

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* 6. A typical peer group meets at least twice annually at locations to be determined across the country. Are you willing to commit to this level of participation?

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* 7. What are your goals and expectations of participating in a Peer Group?

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* 8. Additional questions concern or comments.