CSR Competition Registration Form

AUTO GLASS CUSTOMER SERVICE REPRESENTATIVE COMPETITION REGISTRATION FORM

Preliminary rounds held July 17-28. Finalists invited to compete live at AGW.

All CSR Finalists also receive all the benefits of a Full Attendee Registration and one ticket to the Closing Event and Awards.
Please email Donna Stivers, dstivers@glass.com, with questions.

Competitor 1

Competitor Information

First Name:
Last Name:
Email:
Title:
Company:
Address:
City:
State/Province:
Postal Code:
Country:
Company Phone:
Mobile Phone:


Please check the ONE category that BEST describes the business activity of your company:
	Retailer/Dealer
	Distributor/Wholesaler
	Manufacturer/Fabricator of OE related products
	Manufacturer/Fabricator of AGR related products
	Manufacturer/Fabricator of both OE and AGR related products
	Other AGR-related company
Please select the ONE category that BEST describes your title and function:
	Owner, president or other managers
	Repair technicians / automotive glass installer
	Technical Engineers
	Claims adjuster, agent or other insurance official
	Others in the field (please specify below)

Please check all of the following that you do in procuring products and services for your company (at least one answer is required).
	Recommend
	Specify
	Purchase

Select Registration

	AUTO GLASS CUSTOMER SERVICE REPRESENTATIVE - $99.00 USD
Scheduling/Booking System You Use:

Add Another Competitor

* If you decide not to add another registrant you will need to uncheck this box before you can submit the form.

Competitor 2

Use Same Company Information

Competitor Information

First Name:
Last Name:
Email:
Title:
Company:
Address:
City:
State/Province:
Postal Code:
Country:
Company Phone:
Mobile Phone:


Please check the ONE category that BEST describes the business activity of your company:
	Retailer/Dealer
	Distributor/Wholesaler
	Manufacturer/Fabricator of OE related products
	Manufacturer/Fabricator of AGR related products
	Manufacturer/Fabricator of both OE and AGR related products
	Other AGR-related company
Please select the ONE category that BEST describes your title and function:
	Owner, president or other managers
	Repair technicians / automotive glass installer
	Technical Engineers
	Claims adjuster, agent or other insurance official
	Others in the field (please specify below)

Please check all of the following that you do in procuring products and services for your company (at least one answer is required).
	Recommend
	Specify
	Purchase

Select Registration

	AUTO GLASS CUSTOMER SERVICE REPRESENTATIVE - $99.00 USD
Scheduling/Booking System You Use:

Add Another Competitor

* If you decide not to add another registrant you will need to uncheck this box before you can submit the form.

Competitor 3

Use Same Company Information

Competitor Information

First Name:
Last Name:
Email:
Title:
Company:
Address:
City:
State/Province:
Postal Code:
Country:
Company Phone:
Mobile Phone:


Please check the ONE category that BEST describes the business activity of your company:
	Retailer/Dealer
	Distributor/Wholesaler
	Manufacturer/Fabricator of OE related products
	Manufacturer/Fabricator of AGR related products
	Manufacturer/Fabricator of both OE and AGR related products
	Other AGR-related company
Please select the ONE category that BEST describes your title and function:
	Owner, president or other managers
	Repair technicians / automotive glass installer
	Technical Engineers
	Claims adjuster, agent or other insurance official
	Others in the field (please specify below)

Please check all of the following that you do in procuring products and services for your company (at least one answer is required).
	Recommend
	Specify
	Purchase

Select Registration

	AUTO GLASS CUSTOMER SERVICE REPRESENTATIVE - $99.00 USD
Scheduling/Booking System You Use:

Add Another Competitor

* If you decide not to add another registrant you will need to uncheck this box before you can submit the form.

Competitor 4

Use Same Company Information

Competitor Information

First Name:
Last Name:
Email:
Title:
Company:
Address:
City:
State/Province:
Postal Code:
Country:
Company Phone:
Mobile Phone:


Please check the ONE category that BEST describes the business activity of your company:
	Retailer/Dealer
	Distributor/Wholesaler
	Manufacturer/Fabricator of OE related products
	Manufacturer/Fabricator of AGR related products
	Manufacturer/Fabricator of both OE and AGR related products
	Other AGR-related company
Please select the ONE category that BEST describes your title and function:
	Owner, president or other managers
	Repair technicians / automotive glass installer
	Technical Engineers
	Claims adjuster, agent or other insurance official
	Others in the field (please specify below)

Please check all of the following that you do in procuring products and services for your company (at least one answer is required).
	Recommend
	Specify
	Purchase

Select Registration

	AUTO GLASS CUSTOMER SERVICE REPRESENTATIVE - $99.00 USD
Scheduling/Booking System You Use:

Add Another Competitor

* If you decide not to add another registrant you will need to uncheck this box before you can submit the form.

Competitor 5

Use Same Company Information

Competitor Information

First Name:
Last Name:
Email:
Title:
Company:
Address:
City:
State/Province:
Postal Code:
Country:
Company Phone:
Mobile Phone:


Please check the ONE category that BEST describes the business activity of your company:
	Retailer/Dealer
	Distributor/Wholesaler
	Manufacturer/Fabricator of OE related products
	Manufacturer/Fabricator of AGR related products
	Manufacturer/Fabricator of both OE and AGR related products
	Other AGR-related company
Please select the ONE category that BEST describes your title and function:
	Owner, president or other managers
	Repair technicians / automotive glass installer
	Technical Engineers
	Claims adjuster, agent or other insurance official
	Others in the field (please specify below)

Please check all of the following that you do in procuring products and services for your company (at least one answer is required).
	Recommend
	Specify
	Purchase

Select Registration

	AUTO GLASS CUSTOMER SERVICE REPRESENTATIVE - $99.00 USD
Scheduling/Booking System You Use:

Add Another Competitor

* If you decide not to add another registrant you will need to uncheck this box before you can submit the form.

Competitor 6

Use Same Company Information

Competitor Information

First Name:
Last Name:
Email:
Title:
Company:
Address:
City:
State/Province:
Postal Code:
Country:
Company Phone:
Mobile Phone:


Please check the ONE category that BEST describes the business activity of your company:
	Retailer/Dealer
	Distributor/Wholesaler
	Manufacturer/Fabricator of OE related products
	Manufacturer/Fabricator of AGR related products
	Manufacturer/Fabricator of both OE and AGR related products
	Other AGR-related company
Please select the ONE category that BEST describes your title and function:
	Owner, president or other managers
	Repair technicians / automotive glass installer
	Technical Engineers
	Claims adjuster, agent or other insurance official
	Others in the field (please specify below)

Please check all of the following that you do in procuring products and services for your company (at least one answer is required).
	Recommend
	Specify
	Purchase

Select Registration

	AUTO GLASS CUSTOMER SERVICE REPRESENTATIVE - $99.00 USD
Scheduling/Booking System You Use:

Add Another Competitor

* If you decide not to add another registrant you will need to uncheck this box before you can submit the form.

Competitor 7

Use Same Company Information

Competitor Information

First Name:
Last Name:
Email:
Title:
Company:
Address:
City:
State/Province:
Postal Code:
Country:
Company Phone:
Mobile Phone:


Please check the ONE category that BEST describes the business activity of your company:
	Retailer/Dealer
	Distributor/Wholesaler
	Manufacturer/Fabricator of OE related products
	Manufacturer/Fabricator of AGR related products
	Manufacturer/Fabricator of both OE and AGR related products
	Other AGR-related company
Please select the ONE category that BEST describes your title and function:
	Owner, president or other managers
	Repair technicians / automotive glass installer
	Technical Engineers
	Claims adjuster, agent or other insurance official
	Others in the field (please specify below)

Please check all of the following that you do in procuring products and services for your company (at least one answer is required).
	Recommend
	Specify
	Purchase

Select Registration

	AUTO GLASS CUSTOMER SERVICE REPRESENTATIVE - $99.00 USD
Scheduling/Booking System You Use:

Add Another Competitor

* If you decide not to add another registrant you will need to uncheck this box before you can submit the form.

Competitor 8

Use Same Company Information

Competitor Information

First Name:
Last Name:
Email:
Title:
Company:
Address:
City:
State/Province:
Postal Code:
Country:
Company Phone:
Mobile Phone:


Please check the ONE category that BEST describes the business activity of your company:
	Retailer/Dealer
	Distributor/Wholesaler
	Manufacturer/Fabricator of OE related products
	Manufacturer/Fabricator of AGR related products
	Manufacturer/Fabricator of both OE and AGR related products
	Other AGR-related company
Please select the ONE category that BEST describes your title and function:
	Owner, president or other managers
	Repair technicians / automotive glass installer
	Technical Engineers
	Claims adjuster, agent or other insurance official
	Others in the field (please specify below)

Please check all of the following that you do in procuring products and services for your company (at least one answer is required).
	Recommend
	Specify
	Purchase

Select Registration

	AUTO GLASS CUSTOMER SERVICE REPRESENTATIVE - $99.00 USD
Scheduling/Booking System You Use:

Add Another Competitor

* If you decide not to add another registrant you will need to uncheck this box before you can submit the form.

Competitor 9

Use Same Company Information

Competitor Information

First Name:
Last Name:
Email:
Title:
Company:
Address:
City:
State/Province:
Postal Code:
Country:
Company Phone:
Mobile Phone:


Please check the ONE category that BEST describes the business activity of your company:
	Retailer/Dealer
	Distributor/Wholesaler
	Manufacturer/Fabricator of OE related products
	Manufacturer/Fabricator of AGR related products
	Manufacturer/Fabricator of both OE and AGR related products
	Other AGR-related company
Please select the ONE category that BEST describes your title and function:
	Owner, president or other managers
	Repair technicians / automotive glass installer
	Technical Engineers
	Claims adjuster, agent or other insurance official
	Others in the field (please specify below)

Please check all of the following that you do in procuring products and services for your company (at least one answer is required).
	Recommend
	Specify
	Purchase

Select Registration

	AUTO GLASS CUSTOMER SERVICE REPRESENTATIVE - $99.00 USD
Scheduling/Booking System You Use:

Add Another Competitor

* If you decide not to add another registrant you will need to uncheck this box before you can submit the form.

Competitor 10

Use Same Company Information

Competitor Information

First Name:
Last Name:
Email:
Title:
Company:
Address:
City:
State/Province:
Postal Code:
Country:
Company Phone:
Mobile Phone:


Please check the ONE category that BEST describes the business activity of your company:
	Retailer/Dealer
	Distributor/Wholesaler
	Manufacturer/Fabricator of OE related products
	Manufacturer/Fabricator of AGR related products
	Manufacturer/Fabricator of both OE and AGR related products
	Other AGR-related company
Please select the ONE category that BEST describes your title and function:
	Owner, president or other managers
	Repair technicians / automotive glass installer
	Technical Engineers
	Claims adjuster, agent or other insurance official
	Others in the field (please specify below)

Please check all of the following that you do in procuring products and services for your company (at least one answer is required).
	Recommend
	Specify
	Purchase

Select Registration

	AUTO GLASS CUSTOMER SERVICE REPRESENTATIVE - $99.00 USD
Scheduling/Booking System You Use:

Please select the 1 item that brought you to this registration page:

If you selected Other, please specify:

NOTE: If you returned to this page to make changes to your registration you may need to recheck the agreement box below.

By attending, you understand and allow publisher, exhibit management, sponsors/exhibitors and/or partners to contact you via email, fax, phone and text in the future. Sponsors are considered attendees and are subject to attendee policy and privacy policy. Sponsors/Exhibitors, for additional information, please see Section 3A of the Rules & Regulations, as well as Section 4 for insurance requirements. By submitting this form, I agree to the terms and conditions in the Auto Glass Week Rules and Regulations.

I am not a robot: 3 + 2 =