GOVERNOR'S INDUSTRY APPRECIATION LUNCHEON

GOVERNOR'S INDUSTRY APPRECIATION LUNCHEON DISTINGUISHED BUSINESS NOMINATION FORM

Southern Nevada Companies: period from JAN. 1, 2001 to DEC. 31, 2001
Northern Nevada Companies: period from JULY 1, 2001 to JUNE 30, 2002

NEVADA LOCATION:

YEAR ESTABLISHED IN NEVADA:

COMPANY NAME:

Local Contact:

Title:

Physical Address:

City:

State:

Postal Code:

Mailing Address:

City:

State:

Postal Code:

Phone:

Fax:

E-mail:

Web Site Address:

Yes No:

If selected as honoree, can the above information
be printed in program booklet?

CORPORATE/HEADQUARTERS LOCATION:

Contact:

Title:

Mailing Address:

City:

Postal Code:

State:

Phone:

Fax:

E-mail:

Web Site Address:

PARENT COMPANY OR SUBSIDIARY OF:

If foreign, what country:

PRODUCT/SERVICE DESCRIPTION:

BUSINESS SECTOR:

MANUFACTURING DISTRIBUTION SERVICE

PERCENTAGE OF PURCHASES FROM NEVADA-BASED SUPPLIERS:

PRODUCT MARKETED:

LOCATION:	PERCENTAGE:
Nevada
United States
International

NUMBER OF NEVADA EMPLOYEES:

BENEFITS (excluding mandatory):

DESCRIBE SAFETY RECORD:

TO MEET CORPORATE CITIZENSHIP REQUIREMENT, DESCRIBE IN-HOUSE PROGRAMS AND/OR COMMUNITY ACTIVITIES THE COMPANY AND/OR ITS EMPLOYEE GROUPS ARE INVOLVED IN:

OTHER FACTOR(S) TO BE CONSIDERED IN EVALUATING YOUR COMPANY:

COMPLETE THIS FORM AND SUBMIT BY: Southern Nevada Companies: return by March 1, 2002
Northern Nevada Companies: return by July 2, 2002
For further information or questions, contact Menyone Thomas at the Nevada Commission on Economic Development at [email protected] or phone (702) 486-2700 / toll-free (800) 336-1600.