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Please provide the following contact information: (NOTE: Fields with a * by them are required) First name Last name Title Organization Address Address (cont.) City State/Province ZIP/Postal Code Country United States Mexico Canada Andorra United Arab Emirates Antigua and Barbuda Anguilla Netherlands Antilles Argentina American Samoa Austria Australia Aruba Barbados Belgium Bahrain Benin Bermuda Brunei Darussalam Bolivia Brazil Bahamas Bhutan Bouvet Island Belize Cocos (Keeling) Islands Switzerland Cook Islands Chile China Colombia Costa Rica Christmas Island Cyprus Czech Republic Germany Denmark Dominica Dominican Republic Ecuador Spain Finland Fiji Falkland Islands Micronesia Faroe Islands France Great Britain Grenada French Guyana Ghana Gibraltar Greenland Guinea Guadeloupe Greece S. Georgia & S. Sandwich Isls. 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Approximate number of participants? Please Choose 1-10 Participants 1-10 Participants 25-50 Participants 50-100 Participants 100-200 Participants 200-500 Participants 500-1000 Participants Over 1000 Participants 3. Approximate budget for your next incentive program? Please Choose $1,000 - $5,000 $5,000 - $10,000 $10,000 - $50,000 $100,000 - $500,000 $500,000 and up 4. I use incentives for : Sales Programs Consumer Promotions Dealer/Distributor Programs Employee Recognition Business Gifts Safety Programs Loyalty Programs Non-profit Fundraising 5. Time frame for the start of the program? Please Choose Within 1 Month 1-3 Months 3-6 Months 6-12 Months Over 1 Year Away 6. How often do you implement incentive programs? Please Choose Monthly Quarterly Semi-Annually Annually Other 7. What type of awards are you currently using, or have used? Please Choose Merchandise/Premiums Travel Gift Certificates Cash Debit Cards Phone Cards Other Copyright © 2003 by The Sharper Image. 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