Welcome to the Public Works Summit 2019 Registration

Please complete the below form to apply for the Summit. Make sure to complete the entire form and then click the blue "Continue" button. Please feel free to call Stuart Aizenberg at 847-410-2442 with any questions. We look forward to reviewing your application!

Event: Public Works Summit 2019
First Name*
First Name on Badge (if different)
Last Name*
Your Title*
Company*
E-Mail*
Confirm E-Mail*
Work Address*
City*
State (two-letter abbreviation)*
ZIP/Postal*
Work Phone Number*
Cell Number*
Emergency Contact Person AND Phone Number*
 
To verify that you're a real human and not an automated spambot, please answer the following question:
Independence Day is the Fourth of*
 
*These fields are required to have a value.

Please tell us about your organization:

What's the population size for which your department serves?

Tell us a little about your organization (If accepted, this information will be printed in an on-site guidebook) :

What do you think your municipality is doing well right now?

What keeps you up at night regarding your organization?

Who are some professionals in the industry you would enjoy spending time with?

If you could join two roundtable discussions with several of your peers, what would the discussion topics be titled?


What is your annual Public Works budget?

Water / Wastewater / Stormwater products and services: What is your projected need?

Please provide a little detail about your needs in this area (type N/A if not applicable):

Roadway / Roadway Repair products & services: What is your projected need?

Please provide a little detail about your needs in this area (type N/A if not applicable):

Waste / Recycling products and services: What is your projected need?

Please provide a little detail about your needs in this area (type N/A if not applicable):

Facilities / Buildings & Grounds products and services: What is your projected need?

Please provide a little detail about your needs in this area (type N/A if not applicable):

Fleet products & services: What is your projected need?

Please provide a little detail about your needs in this area (type N/A if not applicable):

Asset Management Systems: What is your projected need?

Please provide a little detail about your needs in this area (type N/A if not applicable):

Please tell us about any new or continuing capital budget projects you're involved in (type N/A if not applicable):

Please list at least one product or service company you'd like to learn more about. You can enter as many as five:

What is the name and title of your immediate supervisor?

I Agree: If I am selected to attend the Public Works Summit, I agree to be present for all sessions, meetings and functions while at the event.

Please Enter a short Bio

Please only click the "continue" button once. The application will take a moment to process your responses.