ENTRY FORM
Please provide the following information:
(Fields marked with an asterisk (
*
) are mandatory.)
PERSONAL INFORMATION
*
First name:
*
Last name:
*
Complete address:
*
City:
*
Postal code:
*
Daytime telephone:
ext
*
Evening telephone:
ext
*
Email:
*
Job:
Electrical contractor
Designer
Electrician
Architect
General contractor
Engineer
Other, specify:
What business segment do you work in?
(You can select more than one answer.)
Commercial
Industrial
Institutional
Residential
ADDITIONAL INFORMATION
(These fields are not mandatory.)
We want to get to know you better to match our future promotions to your interests. Thank you for taking time to answer the following questions:
Age:
Civil status:
-- Select --
Single
Common-law
Married
Divorced
Widow or widower
Sex:
Female
Male
Do you have children? If yes, how many?
Girl:
Boy:
Annual family income:
-- Select --
Less than $15,000
$15,000 to $29,999
$30,000 to $44,999
$45,000 to $59,999
$60,000 to $74,999
$75,000 to $89,999
$90,000 to $124,999
$125,000 to $149,999
$150,000 to $199,999
$200,000 plus
Educational level completed:
-- Select --
Primary school diploma
Secondary school diploma
Vocational training diploma
College/CEGEP/polytechnic school diploma
University diploma
Leisure activities:
