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Company name *

Primary contact's first & last name *

Contact's title *

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City *

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What is the industry or product focus of your organization? *

Select Industry Agriculture Apparel Banking Biotechnology Chemicals Communications Construction Consulting Consumer Products Education Electronics Energy Engineering Entertainment Environmental Financial Services Food and Beverage Government Healthcare Hospitality Insurance Learning Supplier Machinery Manufacturing Media Not For Profit Pharmaceutical Professional Services Recreation Retail Shipping Technology Telecommunications Transportation Utilities Other

What are your primary reasons for joining the Learning CONSORTIUM? *

How new or advanced is your organization in the use of learning and technology? (We have members at every stage of development!) *

How did you hear about the CONSORTIUM? *

Please select one Attended a MASIE event Colleague Press Other

I understand that I am submitting an application for my organization to join the Masie Learning CONSORTIUM for a 12 month membership at a cost of $5,000.

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