*1.Your Full Name: (will remain confidential)(Required.)

2.Would you personally or a representative of your company like to participate in the process with McKinsey & Company? If YES please fill in the rest of the survey and add contact information to question 5.

YESNO

*3.Chapter:(Required.)

YPO AlbertaYPO Atlantic CanadaYPO British ColumbiaYPO Great Lakes OntarioYPO ManitobaYPO Maple Leaf (Greater Toronto Area)YPO OttawaYPO QuebecYPO TorontoYPO Alberta GoldYPO Gold Atlantic CanadaYPO Gold British ColumbiaYPO Great Lakes Ontario GoldYPO Manitoba GoldYPO Ontario GoldYPO Ottawa GoldYPO Quebec Gold

*4.Company Name:(Required.)

*5.Contact information of the person in your company that will be completing the McKinsey & Company survey:(Required.)

Full name:

Title:

Email address:

Phone number:

6.Comments: