Please fill out the following information prior to downloading the VIP Partnership Form. A representative of Tuscarawas 2020 will contact you shortly to confirm your interest and answer any questions you may have regarding implementation of the program.

*Organization:
*Representative:
Address:
City:
State:	Select One OHIO ALABAMA ALASKA ARIZONA ARKANSAS CALIFORNIA COLORADO CONNECTICUT DELAWARE FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OKLAHOMA OREGON PENNSYLVANIA RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGIN ISLANDS VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING
Zip:
*Primary Phone:
Primary Fax:
*Primary Email:
I’m Interested in the Following Convergent Principles: (check all that apply)
	Marketing
	Partnership
	Economic Retention and Growth
	Education
	Applied Technology
	Technology Infrastructure
	Physical Infrastructure
Comments:
	Type the characters in the image above and click submit