CRN Fast Growth Conference and Awards
October 21, 2010
Hyatt Regency Boston, Boston, MA

Thank you for your interest in the 2010 CRN Fast Growth Conference and Awards Reception. CRN is bringing together the top channel executives with the fastest growing Solution Provider organizations in North America. These are the companies who are creating new customer demand and growing at phenomenal rates. The goal of this event is to bring top channel executives together with the fastest growing Solution Providers in an intimate setting where relationships are formed and business opportunities take place.

Please note: Registration does not guarantee entrance to this event. Due to overwhelming response to this event, it is necessary to limit the number of reservations available. We will be contacting you shortly to let you know your status for this event.

For more information on the CRN Fast Growth Conference and Awards, please contact Liz Donovan at 508-416-1146 or Elizabeth.Donovan@ec.ubm.com.

•Required Information
•Company Name:
•First Name:
•Last Name:
•Job Title:
•Address Line 1 :
Address Line 2 :
•City:
•State:
•Zip:
•Country:
•Telephone:  Ext
•Cell Phone:
•Email:
•Website:
•Is your organization a CRN Fast Growth Company?
•What territory does your company cover?
•What is the number of employees in your entire organization (including all divisions, branches, and subsidiaries)?
•What year was your company established?
•What are your entire firm's approximate gross annual sales? (in US Dollars)
(Example: $5.5 Million)
•How do you expect your company's gross revenue (sales) to change during the next 12 months?
•What percent of your total revenue is derived from each of the following? (Note: Must add up to 100%)
Hardware Sales: %
Software Sales: %
Services/Support Sales: %
•Which of the following partner programs does your company participate in? (To select multiple answers, please hold down the Ctrl key)
•Please identify your company's primary and secondary distribution partners.
Primary Distributor
(Select One)		 Secondary Distributor
(Select All)		  
Arrow
ASI
Avnet/Hallmark
Catalyst/Telecom
CDW/CDWG
Comstor
D&H
Ingram Micro
Scan Source
SED
Synnex
Tech Data
Tessco
Westcon
Other
If Other:
•What is the total value of Hardware, Software, and Services that you will purchase this year from distribution, manufacturers, other Solution Providers, or any other source as elements to the solutions you will deliver to your clients?

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