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Please complete this form to provide information that we can use to match you with a group:

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* 1. Please rate the following 4 items in the order of importance to you (1=Most to 4=Least):

* 2. Please indicate your own size, service area type, services/initiatives, and vision:

* 3. The top 3 challenges you will need to address this year are:

* 4. Are you currently looking to merge, acquire, or be acquired?

* 5. Your top 3 non-work-related hobbies or interests are:

* 6. Potential peers you think might be a good fit for a peer group with you are:

* 7. Please provide your Contact information:

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