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First Name*

Last Name*

Job Title *

Company Name *

Country *

United States Others

Address 1 *

Address 2

City/Town *

State/ Province *

Select...AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasU.S. Minor Outlying IslandsUtahVermontVirgin Islands of the U.S.VirginiaWashingtonWest VirginiaWisconsinWyomingOthers

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What is your job function?

IT Management CIO/CTO EVP, Head of Technology SVP, Managing Director VP, Director, Manager Other IT Management

Corporate Management CEO/Chariman/President Chief Operating Officer Chief Financial Officer Chief Compliance, Risk, Security or Data Officer Other Corporate Management

Senior Business Management EVP, Partner, Head of Business Unit SVP, Managing Director Vice President (Other than IT management) Director (Other than IT management) Other Senior Management

Division Department Management Department Manager Division Head/Manager Operations Manager Line of Business Manager Other Division/Department Management Other (please specify)

How many people are employed in your entire organization including all branches, divisions, and subsidiaries? (Select one only) *

Total Employees in your entire organization 1. Over 40,000 2. 30,001 - 40,000 3. 20,001 - 30,000 4. 10,001 - 20,000 5. 5,001 - 10,000 6. 1,001 - 5,000 7. 501 - 1,000 8. 100-500 9. Less than 100

What is your firm's primary business? *

Please select an industry..... 1. P&C Insurance Carrier 2. Health Insurance Carrier 3. Life & Annuity Carrier 4. Multi Line Insurance Carrier 5. Reinsurance Carrier 6. Agency/Broker 7. Life & Annuity Agency/Broker 8. Health Insurance Agency/Broker 9. P&C Insurance Agency/Broker 10. Other (please specify)

If your industry is "Other" please specify:*

What is the total revenue of your organization? (Select one only) *

Total annual revenues of entire organization 1. Over $40 Billion 2. $30 Billion to $39.9 Billion 3. $15 Billion to $29.9 Billion 4. $10 Billion to $14.9 Billion 5. $5 Billion to $9.9 Billion 6. $1 to $4.9 Billion 7. $501 to $999 Million 8. $101 to $500 Million 9. $50 to $100 Million 10. Under $50 Million

Please specify the area(s) of the business you work in and/or where you have purchasing influence *

• Application Development
• Architecture/Infrastructure
• Business Process Management
• Claims
• Compliance
• Customer Service/CRM
• Data Center
• Data Management
• Distributed Computing
• Distribution/Delivery Channels
• Finance/Accounting/Actuarial/Investment Mgmt
• Hardware
• Mobility/Wireless
• Networks & Connectivity
• Outsourcing
• Risk Management/Underwriting
• Security
• Voice Networks

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