Online Registration for the 2008 Procurement Conference

Contact Name: *

Company Name: *

Number of Attendees: *

Address 1:

Address 2:

City:

State:

Zip:

Primary Product or Service:

E-Mail: *

Phone: *

Website:

Is your company a small business as defined by the SBA?
Yes
No

Are you a PICC client?
Yes
No

Is your company owned by?
Minority
Women
Veteran
Disabled Veteran

Is your company registered on the Central Contract Register (CCR) as a
Minority
Women
Veteran
Disabled Veteran

Is your company state of Indiana certified as?
Minority
Women

Does your company have any of the following designations?
Certified: HUB Zone
8A
SDB
DOT Small Disadvantaged Business