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Governor's Workshop on Job Creation

Registration Request Form

**Please note seating is limited**

Name of your business:
Street address:
City:
State:
Zip:
Website:

Please list the name and title of each individual representing your business at this event. You may register up to three people:

Attendee 1 name and title:

Attendee 2 name and title:

Attendee 3 name and title:

Please indicate a contact person, contact number and contact email below:

Contact Name:
Contact Email:
Contact Phone:

Please indicate which event you would like to attend:

Roberts Learning Center, University of Maine at Farmington

August 15, 2012

* Registration Deadline is August 10, 2012

Tell us about your business:

How many years have you been in business:
What sector are you in? (Mark all that apply)	Service: Retail: Tourism: Manufacturing: Technology: Healthcare: Other:
Tell us about what your business does, or the service it provides (in 50 words or less):
How many employees does your business currently have (FTE's)?
Have you created any new jobs since January 1, 2012? If so, how many?
Do you anticipate creating any new jobs in 2012?
What is the single largest inhibitor to job creation you currently face?
May we have permission to publicize your business?	Yes: No:

Please note: to attend you will need a registration confirmation which will come by email. Please look for a confirmation by email. Space is limited. Not all requests may be fulfilled.

Credits

Information

Though the Governor and his Administration respect the privacy of Maine citizens, any written or electronic communication sent to the Governor, or any other public officer or employee, could be considered a public record and therefore be subject to disclosure under the Freedom of Access Act.

Maine.gov

Office of Maine Governor Paul LePage