Customer / Consultant Registration

*Denotes a required field

Company:*

First Name:*

Last Name:*

Phone Number:*

Email Address:*

Are you:*

	Siemens Direct Customer
	Siemens Distributor Customer (Indirect)
	Industry Consultant
	I am not yet a Siemens Customer (Special Invitation)

Partner Company:

Account Manager's Name:

What is your title/role in the organization?*

Are you a JUST-US Member?

Yes No

Which Open Minds Summit will you be attending?

Chicago, IL (Central)

Yes No

Santa Clara, CA (West)

Yes No

	Prospective clients and Consultants are invited as our special guest to attend the first day (afternoon sessions and reception) only. Refer to your account representative for more details.
8.	Tell us who referred you to the Open Minds Summit?
	Siemens would like to recognize that individual (Sales or Service) for recommending you to our customer event.
9.	Do you want to meet with any of these specific resources while attending?	Siemens Sales Executive Siemens Service Executive JUST-US Board Members No meeting is necessary

10.

Please provide a brief summary of your private meeting requirement.

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For hotel details on the Open Minds Summit you will be attending, click here.

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