EIR Engagement Intake Form
Email address *
First Name *
Last Name *
Phone Number *
Job Title *
Department *
Company Name *
Company URL *
Describe the issue/ topic you'd like to discuss with an EIR member. *
Company Size (# Employees) *
Company Phase *
Type of Business *
Market Vertical *
Is there a particular EIR member (or 2) you'd like to connect with? For member profiles, visit http://www.techoregon.org/who-we-are/executives-residence) *
A copy of your responses will be emailed to the address you provided.
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This form was created inside of Technology Association of Oregon.