EmailMe Form - NC TECH Diversity Benchmark Registration

DESIGNATED CONTACT(S)

The primary contact is the individual appointed to serve as the 'company' representative for the diversity benchmark. They will be the main liaison to facilitate the core assessment. A secondary contact is recommended though not required.

Primary Contact Name

First Last

Primary Contact Title

Primary Contact Email

Primary Contact Phone

### - ### - ####

SECONDARY CONTACT

Secondary Contact Name

First Last

Secondary Contact Title

Secondary Contact Email

Secondary Contact Phone

### - ### - ####

BACKGROUND INFORMATION

Is your company headquartered in North Carolina?

Yes

No

How many employees are in your company?

How many employees in your company are based in North Carolina?

How many employees will be invited to participate in the People + Perceptions assessment?

How would you classify your company?

Technology company

Technology-enabled company/organization

What industry best describes your organization?

What are your biggest challenges regarding DEI?

What are your biggest strengths regarding DEI?

PAYMENT INFORMATION

The registration fee must be paid by January 31st.

Registration Selection

Member Registration ($1,500)

Non-Member Registration ($3,000)

Payment Selection

Invoice (to primary contact)

Credit Card (complete below)

Credit Card Number

Expiration Month

Expiration Year

CVC

Billing Zip Code

COMPANY INFORMATION

DESIGNATED CONTACT(S)

SECONDARY CONTACT

BACKGROUND INFORMATION

PAYMENT INFORMATION