Thank you for your interest in attending IT ChannelVision: Government Edition. We ask that you complete and submit the following Event Interest Form. After reviewing your submitted form we will contact you with a response and/or confirmation.

• Required Information
•Contact Name:
•Contact Title:
•Sender E-mail:
•Telephone:
•Fax:
•Company Name:
•Corporate Address 1:
•Corporate Address 2:
•City:
•State:
•Zip/Postal Code:
•Company URL:
•Indicate your primary business focus:	Select One IT Consultant Systems Integrator Total Solution Provider Reseller Distributor Other
Other:
•To what degree are you responsible for building the vendor partnerships and alliances for your company:	Select One Total Responsibility Partial Responsibility Minor Responsibility No Responsibility
•Does your company have a practice area/division focused on the government sector?	YesNo
•Are you part of this practice area?	YesNo
•What is your company's total annual revenue?	Select One <1M $1-4M $5-10M $11-25M $26-50M $51-100M $101-300M $301-500M $501M-1B >$1B
•What percentage of this total revenue was from business in the federal sector?	Select One 0% 1-10% 11-25% 26-50% 51-75% 76-100%
•What percentage of this total revenue was from business in the state & local government?	Select One 0% 1-10% 11-25% 26-50% 51-75% 76-100%
•What percentage of this total revenue was from corporate business?	Select One 0% 1-10% 11-25% 26-50% 51-75% 76-100%
•What are your revenue projections for the upcoming year?	Select One <1M $1-4M $5-10M $11-25M $26-50M $51-100M $101-300M $301-500M $501M-1B >$1B
•What percentage of this total revenue do you expect from business in the state & local government?	Select One 0% 1-10% 11-25% 26-50% 51-75% 76-100%
•What percentage of this total revenue do you expect from business in the federal sector?	Select One 0% 1-10% 11-25% 26-50% 51-75% 76-100%
•What percentage of your business is done directly with the federal government (prime)?	Select One 0% 1-10% 11-25% 26-50% 51-75% 76-100%
•What percentage of your federal business is through channel partners (subcontractor)?	Select One 0% 1-10% 11-25% 26-50% 51-75% 76-100%
Other:
•What percentage of your total revenue comes from the following areas (must total 100%)?	Hardware % Software % Services %
•Top three federal technology vendors you work with (Cisco, EMC, Microsoft):
•Is your company on a GWAC?	YesNo
•What percentage of your company revenue is generated from the following agencies? (Total = 100%) If the following categories are not applicable, type 0%.
Federal: Department of Agriculture: % Department of Interior: % Department of Commerce: % Department of Defense: % Department of Labor: % Department of Education: % Department of State: % Department of Energy: % Department of Transportation: % Department of Health & Human Services: % Department of Homeland Security: % Department of Veterans Affairs: % Department of Housing & Urban Development: % Environmental Protection Agency: % : % State & Local Government: Administration & Finance (Includes Revenue/Tax): % Health: % Human Services: % Transportation: % Public Safety: % Criminal Justice: % Public Works: % Natural Resources: % : %
Which, if any, SBA certification do you hold?	Select One HUBZone Veteran minority-owned business SDB/8(a) None Other
Other:
Event Interest On a scale of 1-4 please rate the following interests with 1 being the highest: •meeting and partnering with vendors providing federal solutions? 1   2   3   4 •meeting and partnering with federally focused solution providers? 1   2   3   4 •meeting and partnering with top ten prime contractors? 1   2   3   4 •meeting and partnering with federally focused small disadvantaged businesses? 1   2   3   4 •meeting with a Gartner Analyst? 1   2   3   4 •access to Gartner research? 1   2   3   4
• How did you hear about our site?	Select one... Advertisement Brochure Editorial E-mail Fax Gartner Client Gartner Web Site Governing.com GovExecutive.com Postcard Press Releases Previous Attendee Referral Sales Associate Other Web site Other
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