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TSPE/ACEC of TN Partners Program Application

Company                                                                                                                                                    

 

Address                                                                          City _______________ State______Zip                    

                       

Telephone____________________ FAX __________________Web Site                                                           

 

Chief Executive Officer                                                                                                                                

 

Are any of the Officers/Principals Professional Engineers?     _______Yes      ______No

 

Designated Representative for TSPE and ACEC of TN communications  (2 Max) including email address:

Name                                                                       Email address

 

                                                                                                                                                                 

 

                                                                                                                                                                 

 

Number of years in business _________   Type of Business                                                                              

 

Describe your business and services                                                                                                                

 

                                                                                                                                                                 

 

Do you represent any particular services, brands or products? _____Yes ______No

 

If yes, which ones?                                                                                                                                       

 

Please list 2 business references (name and company)

 

(1)                                                                                                                                                             

 

(2)                                                                                                                                                             

 

How did you hear about the Partners Program?                                                                                               

 

                                                                                                                                                                 

 

Are you interested in advertising in the TSPE newsletters or sponsoring ACEC of TN and TSPE events?

_____Yes   _____Not at this time

 

Date  _____________________

July 2007

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