Expert Request Form

20/05/2012

Dear Sir or Madam, we appreciate that you kindly fill out our Atheneum partners request form in order to understand your requirements.

This form, upon submission, will be securely delivered to an Atheneum Partners Project Manager.

The Project Manager will contact you to complete the scope and initiate the project.

* = Required field

Company name (*)		Location (*)

Primary contact name (*)		Secondary contact name

Primary contact office phone (*)		Secondary contact office phone

Primary contact mobile phone		Secondary contact mobile phone

Primary contact email		Secondary contact email

Case code (if applicable)

Industry sector (*)		Industry sub-sector

Description and scope of the project (*)

Key questions to address to experts (*)

Can Atheneum Partners utilize your company name when contacting experts?

Please attach any relevant articles, interview guides or supporting material *If you require to send more than one file, please compress it in .zip format

Experts per countries to be covered (*)

Number of experts required (*)

Relevant companies of focus

Companies not to be contacted

Preferred titles and positions

Are relevant independent consultants of interest to be contacted?

Are ex employees from relevant companies to be contacted?

English language		Other languages

Date of beginning expert interviews	--

Date of project completion (all interviews should be completed)	--

Preferred mode of scheduling	Client manages scheduling Atheneum manages scheduling invites, e.g., outlook

If applicable, Atheneum Partners will contact you to find suitable timings

Please indicate any further comments you may have

Contact Person/Office

Before submitting the request, please read the Compliance Agreement

Read policy

We thank you for entrusting Atheneum Partners as your professional services partner.