(* Indicates required field) Contact Information
First name*	Last name*
Title*	Company name*
E-mail address*
Address 1*
Address 2
City*	State or province* Please Select..................... Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming Canadian Provinces ------------------------------- Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Québec Saskatchewan Yukon Territory ------------------------------- --None of Above--
ZIP code*	Country* Please Select..................... United States Canada Afghanistan Albania Algeria Andorra Angola Antigua & Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia & Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Cape Verde CentralAfricanRepublic Chad Chile China China-Hong Kong Colombia Comoros Congo Costa Rica Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador England Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France FYRO Macedonia Gabon Georgia Germany Ghana Greece Grenada Guatemala Guinea Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgystan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Morocco Mozambique Namibia Nauru Nepal Netherlands Netherlands Antilles New Zealand Nicaragua Niger Nigeria North Korea Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Romania Russia Rwanda Saint Lucia San Marino São Tomé and Príncipe Saudi Arabia Scotland Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Korea Spain Sri Lanka St Kitts and Nevis Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand The Gambia Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Western Samoa Yemen Zaire Zambia Zimbabwe Puerto Rico Other

Phone*

Fax (opt)

Mobile (opt)

Partner

Please select one (1) Intended program of interest:*

Strategic Alliance Partner Program Solutions Partner Program Reseller Partner Program

Program Interest

Intent is added value resale of Telava Products and Services to end users.

YesNo

Intent is to co-market solutions that add value to Telava but not to resell Telava Products and Services.

YesNo

Intent is to provide consulting services and to refer but not to resell Telava Products and Services to end users.

YesNo

Company Information
Company website*	Year established*
Number of Employees*	Number of Sales People*
Annual revenue (in US dollars)*	Quantity of Customers*
Type of ownership* Please Select..................... Publicly Held Privately Held	Stock symbol (if public)

Company Profile

What is your core business?*

Please Select.............. Consultant ISV - Independent Software Vendor Events Management OEM Networking Systems Integrator Telecommunications Training/Learning Value Added Reseller Other

If Other (please explain)

Do you sell usage-based products? (ie. conferencing, ISP, hosted applications, etc.)

YesNo

Provide a brief overview of your products and or services?*

How do you sell your current product/service offerings?*

Please Select............................ Direct sales Indirect sales Online/Web sales Telemarketing Direct mail Other

If Other (please explain)

What is your principal vertical market?*

Please Select........ all Government Aerospace Defense Healthcare Computing Manufacturing Consulting Retail Education Telecommunications Energy Transportation Environment Utilities Financial Services Other

If Other (please explain)

What is your target market focus? (check all that apply)

Customer Small business (1-99 employees) Medium business (100-499 employees) Enterprise (500+ employees) Other (please explain)

What geographical areas do you primarily serve? (check all that apply)

North America Latin/South America Asia/Pacific Europe Middle East/Africa

What do you use today for web conferencing?

Telava None Other (please list)

Describe your interest in a Telava partnership?*

Please subscribe me to Telava mailing lists:
Telava Customer Newsletter	YesNo
Telava Partner Newsletter	YesNo
Web Seminar & Event Alert	YesNo
Occasional special offers	YesNo