Registration

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.

I have authorization from the executive(s) to enter this organization into the program.

You must agree to this statement.

The organization I am registering meets the Who Can Participate criteria.

You must agree to this statement.

Our organization must complete the two-part survey process including the Employer Assessment (EA) and the Employee Feedback Survey (EFS) according to the outlined Important Dates. You must agree to this statement.

Our organization must receive a minimum number of responses on the survey to ensure our data is credible. If not enough responses are received, our ability to be considered for the list or to receive a statistically valid Employee Feedback Data Dashboard may be impacted. You must agree to this statement.

We understand that we have until January 10, 2025 to withdraw from this process without incurring a non-refundable $199 withdrawal fee. We are responsible for paying any additional fees for optional services that we have ordered (paper fees, customization, translation fees, additional reporting, etc). You must agree to this statement.

By entering my name below, I agree and commit to all of the above statements and confirm that I am authorized by the executive(s) of this organization. You must agree to this statement.

I agree to Workforce Research Group's Privacy Policy, GDPR, and CCPA disclosures regarding the storage, processing, and/or transmission of my personal data. You must agree to this statement.

First Name*

First name needed.

Last Name*

Last name needed.

Title*

Title needed.

Phone*

Valid phone needed.

Extension

Invalid

Email *

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 to be corrected.

Organization Information

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

Organization Name*

Response required.

Legal Name

Response required.

FEIN/Business Number*

Valid response required.

Mailing Address

Street Address*

Response required.

Address Line 2

Invalid Input

City*

Response required.

State*

Response required.

ZIP / Postal Code*

Response required.

Organization County*

Response required.

Website*

Valid response required.

Twitter Handle

Response required.

Industry*

Response required.

Other Industry*

Response required.

Is this the corporate address?*

Response required.

If no, please fill out the corporate address below.

Street Address*

Response required.

Address Line 2

Invalid Input

City*

Response required.

State*

Response required.

ZIP / Postal Code*

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.

Salutation*

Response required.

First Name*

Response required.

Last Name*

Response required.

Title*

Response required.

Phone*

Valid response required.

Phone Extension

Invalid Input

Please do not provide a role-based email address such as hr@abccompany.com or marketing@abccompany.com. Our system will not import role-based email addresses and invitations will not to be delivered.

Email *

Valid response required.

Confirm Email *

Valid response required.

Same as Organization Mailing Address Invalid Input

Street Address*

Response required.

Address Line 2

Invalid Input

City*

Response required.

State*

Response required.

ZIP / Postal Code*

Response required.

Is this contact an employee of the company*

Response required.

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

Salutation

Invalid Input

First Name

Invalid Input

Last Name

Invalid Input

Title

Invalid Input

Phone

Invalid Input

Phone Extension

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 to be corrected.

Contact Information

Tell us about your people.

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

Salutation

Invalid Input

First Name

Invalid Input

Last Name

Invalid Input

Title

Invalid Input

Phone

Invalid Input

Phone Extension

Invalid Input

Same as Organization Mailing Address Invalid Input

Street Address

Invalid Input

Address Line 2

Invalid Input

City

Invalid Input

State

Invalid Input

Zip / Postal Code

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.

Salutation*

Response required.

First Name*

Response required.

Last Name*

Response required.

Phone*

Valid response required.

Phone Extension

Invalid Input

Please do not provide a role-based email address such as helpdesk@abccompany.com or technology@acbcompany.com. Our system will not import role-based email addresses and invitations will not be delivered.

Email*

Valid response required.

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

Salutation*

Response required.

First Name*

Response required.

Last Name*

Response required.

Phone*

Valid response required.

Phone Extension

Invalid Input

Email*

Valid response required.

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

Salutation*

Response required.

First Name*

Response required.

Last Name*

Response required.

Title*

Response required.

Phone*

Valid response required.

Phone Extension

Invalid Input

Email*

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 to be 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 NC Employees	Number of Eligible Employees Surveyed	Online Method Cost	Paper Method Cost*
15-24**	All	$0	$390
25-99	All	$0	$435
100-199	All	$0	$635
200-499	Up to 300***	$0	$835
500-999	400***	$0	$935
1000 and above	500***	$0	$1,135

*Costs are not refundable. **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.

Approximately how many full- and part-time employees work for your organization in North Carolina?*

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 need to pay the cost in the chart above, please select in the drop down menu below if paper option is needed.

Please select.

Number of North Carolina eligible employees as indicated above.*

Response required.

Number of North Carolina eligible employees as indicated above.*

Response required.

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

Yes, I'm interested 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 to be 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.

Spanish – Latin American - 199.00 USD

Spanish – European - 199.00 USD

Portuguese - 199.00 USD

French – Canadian - 199.00 USD

French – Creole - 199.00 USD

French – Parisian - 199.00 USD

Chinese - 199.00 USD

Japanese - 199.00 USD

Other Language - 199.00 USD

Please select.

Language Selector Other*

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 10, 2025 saves you 15% off the price!

Number of Eligible NC Employees	Number of Eligible Employees Surveyed	Report Fee with 15% Discount*(discount ends 01/10/25)	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.}

Select your number of employees

Response required.

Additional Questions

Did this organization participate last year?*

Invalid Input

If yes, please list name of company if different than what is listed on this form.

Response required.

How did you hear about the program?*

Please select.

If Other*

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 to be corrected.

Submit Your Registration

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

Total Fee

0.00 USD

Payment Options

Pay Online

Invoice Me

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

Billing Contact

First Name*

First name needed.

Last Name*

Last name needed.

Email for credit card receipt, if applicable*

Valid email needed.

Phone*

Valid phone needed.

Phone Extension

Invalid

Fax

Valid phone needed.

Billing Address

Same as Organization Mailing Address Invalid Input

Street Address*

Response required.

Address Line 2

Invalid Input

City*

Response required.

State*

Response required.

ZIP / Postal Code*

Response required.

Credit Card Information

Credit Card Number

Invalid Input

Card Security Code (CSC)

Invalid Input

Card Expiry Month

Invalid Input

Card Expiry Year

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 to be corrected.

Prove that you're human*

Response required.