Registration: Area 12 Executive Briefing: 9/15/21

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* 1. Name

First Name

Last Name

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* 2. Title

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* 3. E-mail

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* 4. Company Name (full name as registered with the State of Ohio including commas, etc.)

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* 5. Company Address

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

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* 6. County

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* 7. Phone Number

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* 8. Type of Industry (e.g., construction, service, manufacturing, retail, government)

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* 9. Number of full-time employees

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* 10. Number of part-time employees