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REGISTRATION FORM: INDUSTRY MANUFACTURING AFFILIATES
Your Name: ___________________________ Date of Birth: __ __ ____
Male or Female (optional): M F Mr. Ms. or Mrs. (optional)
Street Address, City, State, Zip: _________________________________
Phone:( ) ___ ____ Fax: ( ) ___ ____ email:______________________
Web site address: if you have one: _______________________________
Regional? Which? ______
National? Yes__ No__
Your Business Product(s):
Internships: We offer to help you create internships in your business for college or graduate students. These students become experts in your products, and in the internships can help find firms to specify your products. Would you be interested in examining the costs and benefits of this program?
Facilitate Your Business Goals: We can devise services delivered through affiliates of the National Architect which can facilitate your business goals. Would you be interested in working with us to identify the costs and benefits of such programs?
Please list three professional or trade references with full contact information.
Contact 1:(name, address, phone, email)
Contact 2:(name, address, phone, email)
Contact 3:(name, address, phone, email)
Why do you want to affiliate with the National Architect?
What will you bring to the National Architect which is unique?
What issues do you find most challenging, and really want to solve?
Annual Subscription Fee: (add to cart)
copyright, National Architect Corporation, 16 September, 2014
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