Information Request Form

* Name  
 Organization  
 Title  
* Address  
* City  
* State    *Zip 
* Phone  
 Fax  
* E-mail  
* I prefer to receive
information via 		 email
 phone
 mail

 I am requesting information about these services: (check all that apply)

 Full Service Management
 Outsourced Services
 Credentialing
 Customer Service & Member Care
 Education
 Finance
 Fulfillment 		 Government Relations
 Marketing
 Meeting & Convention Management
 Order Processing & Data Entry;
 Publishing and Design
 Advertising, Sponsorship & Exhibits Management
 Technology & Web Services

I would like further information as described:

Please complete this section so we can provide appropriate information.

My organization is an
Association
Corporation
Other (please describe):

My organization is currently
Self-managed
With a management company
Contracting brokered services
Other

My organization's focus area is
Medical/Healthcare
Professional Society
Trade Group
Other (please describe):

My organization's size is
less than 1,000
1,001 to 5,000
5,001 to 10,000
more than 10,000

My organization's membership is
International
National
Regional
State
Local

My organization's annual budget is
less than $250,000
$250,000 to $500,000
$500,000 to $1 M
$1 to $3 M
$3 to $5 M
more than $5 M

My organization was established in the year

I am preparing a request for proposal (RFP)

How did you learn about AMC?
Web Search
Referral
ASAE Guide to AMC's
AMC Institute
Association Forum Ad
Other (Please Describe):