SUPPLY CHAIN READY: Capital & Capability Statements Registration Form

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1. Full Name* This field is required.

First Name

Last Name

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2. Email Address:* This field is required.

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3. Phone Number

Area Code

Phone Number

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What is your zip code?

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3. LinkedIn Profile Link

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1. Organization/Company Name:* This field is required.

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2. Job Title:* This field is required.

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3. Are you a U.S.-based company?* This field is required.

YESNO

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4. Are you a sole proprietor?

YESNO

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5. Is your company led by people of color?* This field is required.

YESNO

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Are you a US Veteran?

YESNO

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6. Which industry does your company operate in?(Select all that apply)

Healthcare manufacturing

Diagnostics Nutrition products

Medical devices

Business services (IT, HR, construction, etc.)

Other

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If Other (Please specify):

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7. How long has your company been in operation?* This field is required.

Less than 2 years

2 years or more

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8. What was your company's annual revenue in the last fiscal year?* This field is required.

Less than $250,000

$250,000 or more

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1. Which Free Webinar Session would you like to register for?* This field is required.

Friday, November 15, 2024 - 5:30 pm – 7:00 pm CST

Saturday, November 16, 2024 - 9 am to 10: 30 am CST

Thursday, November 21, 2024 - 5:30 pm to 7 pm CST

Tuesday, December 03, 2024 - 5:30 pm to 6:30 pm CST

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2. What are you hoping to learn from this webinar?

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3. Do you have any specific questions you would like addressed during the webinar?