Registration Deadline: January 21, 2022

Page 1 of 6

 

Your Program Registration Starts Here 

Before completing the registration form on the following page, we need you to agree and commit to the following statements. The form will not submit until all fields are filled out completely.

 

You must agree to this statement.

You must agree to this statement.

You must agree to this statement.

You must agree to this statement.

You must agree to this statement.

You must agree to this statement.

You must agree to this statement.

First name needed.

Last name needed.

Title needed.

Valid phone needed.

Invalid

Valid email needed.

If the form does not proceed to the next page, please review your information throughout the form to see what is missing or what needs corrected.

 

Organization Information

 Tell us about your organization. Please list the HQ or primary location for your operations in Florida.

 

Response required.

Valid response required.

 

Mailing Address

Response required.

Invalid Input

Response required.

Response required.

Response required.

Response required.

Valid response required.

Response required.

Response required.

Response required.

Response required.

If no, please fill out the corporate address below.

Response required.

Invalid Input

Response required.

Response required.

Response required.

 

Contact Information

 Tell us about your people.

 

Primary Contact The Primary Contact will be the main contact for questions throughout the entire process and the recipient of all communications (via emails, phone, website and letters), employee surveys for distribution, feedback reports, etc.

Response required.

Response required.

Response required.

Response required.

Valid response required.

Invalid Input

Valid response required.

Valid response required.

Invalid Input

Response required.

Invalid Input

Response required.

Response required.

Response required.

Response required.

 

Secondary ContactThe Secondary Contact will be the contact for questions if the Primary Contact is unavailable.

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

If the form does not proceed to the next page, please review your information throughout the form to see what is missing or what needs corrected.

 

Contact Information

Tell us about your people.

 

CEO, President, Manager, Etc. (Highest-ranking position of the nominated workplace.)

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

Invalid Input

 

IT Contact The IT Contact will be the contact for any technical systems questions regarding online surveys - for all employer questionnaires and online surveys for employees - regarding filtering, spam content, white-listing, etc.

Response required.

Response required.

Response required.

Valid response required.

Invalid Input

Valid response required.

 

Marketing/PR Contact The Marketing/PR Contact will handle any marketing and/or public relations questions for your organization.

Response required.

Response required.

Response required.

Valid response required.

Invalid Input

Valid response required.

 

Human Resources Contact Human Resources Contact will handle any human resources related questions for your organization.

Response required.

Response required.

Response required.

Response required.

Valid response required.

Invalid Input

Valid response required.

If the form does not proceed to the next page, please review your information throughout the form to see what is missing or what needs corrected.

 

Survey Selection

 

Participation Fees

Your registration fee depends on how many employees you have at your organization. Please see the chart below to determine the survey selection, as well as the fees regarding organization size and survey method. You will receive an invoice at a later date or you can choose to pay online at the end of this form.

Number of Eligible FL Employees Number
of Eligible Employees Surveyed
Online Method Cost Paper Method Cost*
15-24** All $0 $295 + $1.49 x No. of empl surveyed
25-99 All $0 $295 + $1.49 x No. of empl surveyed
100-199 All $0 $295 + $1.49 x No. of empl surveyed
200-499 Up to 300*** $0 $295 + $1.49 x No. of empl surveyed
500-999 400*** $0 $295 + $1.49 x No. of empl surveyed
1000 and above 500*** $0 $295 + $1.49 x No. of empl surveyed

*Costs are not refundable. In addition to the paper cost in the chart above, there is a $1.49 per employee survey charge that will be assessed via invoice. **To ensure result credibility, companies with 15-24 employees are required to have at least an 80% response rate to be considered for the list. ***Employees are randomly selected.

 
Valid numbers needed.

While we recommend online surveys in most cases, sometimes paper is a better option. If more than 40% of your employees do not have their own email address, please select "paper" below. Organizations selecting the paper method will be invoiced an additional $1.49 per employee surveyed in addition to the cost in the chart above and in the drop down menu below.

Please select.

Response required.

Response required.

 

Survey Additional Employees? For employee populations over 300 we survey a random selection or, would you like to survey additional employees?

Invalid Input

If the form does not proceed to the next page, please review your information throughout the form to see what is missing or what needs corrected.

 

Additional Information

Tell us about your survey needs. 

 

Additional Languages Does your organization need alternate language surveys?

Response required.

We offer employee surveys in a variety of languages. Additional languages are available at $199 per survey translation. If you need alternate language surveys, please select the languages below, and we will contact you to confirm your selections. Selecting "YES" above will add $199 to your cart, per language.

Please select.

Please name.

 

Are you interested in customizing your employee survey? As part of the survey design process your organization has the option (for a fee) to customize the employee survey to include changing job roles/department response option selections, adding a location question, surveying all or additional employees and adding additional questions. If selected, you will be contacted by a survey pro to learn more about these options.

Please select.

 

Employee Feedback Data Dashboard: (optional)

After we have collected the responses from your employees, that data is available for purchase in the Employee Feedback Data Dashboard. Answers will be provided to all questions asked on the employee survey in the form of percentage of positive response. Open ended comments and benchmarking data will also be available. The Data Dashboard is an interactive tool where data can be viewed in charts, graphs and downloadable pre-created report formats. Ordering your report package by January 21, 2022 saves you 15% off the price!

 

Number of Eligible FL Employees Number
of Eligible Employees Surveyed
Report Fee with 15% Discount*(discount ends 01/21/22) Report Fee Regular Pricing*
15-24 All $785 $925
25-99 All $810 $955
100-199 All $910 $1,075
200-499 Up to 300** $960 $1,130
500-999 400** $1,030 $1,215
1000 and above 500** $1,070 $1,260

*Costs are not refundable. **Employees are randomly selected.

Response required.

Additional Questions

Invalid Input

Response required.

Please select.

Response required.

If the form does not proceed to the next page, please review your information throughout the form to see what is missing or what needs corrected.

 

Submit Your Registration

You're almost done! (All fees are non refundable)

 

0.00 USD

You have selected to be invoiced. An invoice will be sent to the primary contact of this registration form.

 

 

Billing Contact

First name needed.

Last name needed.

Valid email needed.

Valid phone needed.

Invalid

Valid phone needed.

 

Billing Address

Invalid Input

Response required.

Invalid Input

Response required.

Response required.

Response required.

 

Credit Card Information

Invalid Input

Invalid Input

Invalid Input

Invalid Input

If the form does not proceed to the next page, please review your information throughout the form to see what is missing or what needs corrected.

Response required.

­