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* required fields! Printable form

Please complete the following information and submit this form. Once the Best Companies Group receives this form, you will be sent a confirmation email with detailed information about the survey process.

Company Name (Company name as it should appear in print):
*
Legal Name of the Company (If different than listed above.):
Federal Employer Identification Number (FEIN):
Mailing Address:
(No home addresses)		 *
City:
 *
County: *
State:
Zip Code: *
Company Web Site URL: *
Industry: *
Industry Other:
Primary Contact (This person will be the main contact for questions throughout the entire process and the recipient of all communications (via emails, phone, Web site and letters), employee surveys for distribution, feedback reports, etc.)
Salutation: *
First Name: *
Last Name: *
Title: *
Mailing Address:
(No home addresses)		 *
City: *
State:
Zip Code: *
Direct Dial Phone Number:
(No home or cell phones please)		 *
Fax Number: *
Email Address: *
Secondary Contact (This person will be the contact for questions if the primary contact is unavailable.)
Salutation:
Name:
Title:
Direct Dial Phone Number:
(No home or cell phones please)
Email Address:
CEO, President, Manager, Etc. (Highest-ranking position in the state of the nominated workplace.)
Salutation:
Name:
Title:
Mailing Address:
(No home addresses)
City:
State:
Zip Code:
Direct Dial Phone Number:
(No home or cell phones please)
Email Address:
IT Contact (This person 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: *
Name: *
Direct Dial Phone Number:
(No home or cell phones please)		 *
Email Address:
*
Marketing/PR Contact (This person will handle any marketing and/or public relations questions for your company.)
Salutation: *
Name: *
Title: *
Direct Dial Phone Number:
(No home or cell phones please)		 *
Email Address:
*
Additional Company Information:
Total number of employees in San Diego only (EXCLUDING temporary/seasonal and per diem employees).
Total San Diego Employees: *
Full-time Employees: *
Part-time Employees: *
Total number of employees in the United States (excluding temporary/seasonal and per diem employees).
Total US Employees:
 *
Full-time Employees:
 *
Part-time Employees:
 *
* Participation fee: The fees are based on the size of the company and the selected survey method.
Number of Employees in SD
# Employees Surveyed
Online Fee
Paper Fee(1)
  
15 - 24
All
FREE
$230
25 - 99
All
FREE
$375
100 - 199
All
FREE
$505
200 - 499
Up to 250(2)
FREE
$585
500 - 2499
350(2)
FREE
$685
2500 +
400(2)
FREE
$840
(1) A nominal non-refundable paper fee to cover the cost of printing, processing and shipping the paper surveys.
(2) Employees are randomly selected.
* Survey Type: Please select what kind of survey you would like to receive.
Online Employee Survey (Electronic):
Paper Employee Survey (Hard Copy):
   
Additional Survey Options:
 
Does your company need alternate
language surveys?*
Yes
No
* We offer employee surveys in a variety of languages. Additional languages are available at $205 per survey translation. If you need alternate language surveys, please select the above button and you will receive additional information. If you decide to pay online below, selecting yes to this section will automatically add the $205 to your bill.
 
If Other
Is your company interested in customizing the job role and department category demographics on the employee survey?
Yes, I am interested in receiving more information.
There is a fee of $795 to customize. What is this?
 

Special Offer
Purchase your Employee Feedback Report Now and Save.* This report details the results of your company’s specific survey results to each of the 78 survey questions. The report also includes state benchmarking as well as the employee comments transcribed exactly as submitted by employees. Similar reports can cost thousands of dollars if initiated independently.

Number of
Employees in SD
Pre-survey Pricing (discount)*
Regular Pricing
Savings
  
15 - 24
$740
$820
Save $80
25 - 99
$765
$850
Save $85
100 - 199
$865
$960
Save $95
200 - 499
$915
$1,020
Save $105
500-2499
$985
$1,095
Save $110
2500 +
$1,025
$1,140
Save $115
No, thank you

*After March 23, 2018 the reports go back to regular pricing.
 
Questionnaire:
How did you hear about the program?
If Other
   
Did you participate last year?
If yes, Name of the company if it is
different than above:
   
Please be aware that as part of the “Best” program, a certain threshold of employee survey responses must be received in order for the analysts to consider the survey data valid. If a company does not meet this threshold, their full consideration for the “Best” list may be jeopardized, even resulting in elimination. In the rare case a company’s response rate is extremely low, a statistically valid Employee Feedback Report will not be presented (if purchased).
Name of person completing this registration form:
Your Name:
 *
Your Title:
 *
Your Email Address:
*
Are you authorized to enter your
company into this process:
 *
Commitment:
 * I understand that by clicking this submit button, our company is entered into the "Best Places to Work in San Diego" program. I am committing to meet all deadlines and complete both portions of the assessment process. If at any point we choose to withdraw from the process, we will notify a representative of Best Companies Group at 1-877-455-2159 immediately. Companies withdrawing after March 23, 2018 will incur a $250 withdrawal fee in addition to the total fees incurred for any special requests (customization orders, language translations, paper survey processing, etc.). All fees are non refundable.
IMPORTANT: If any of the contact information changes at any point in the process, please notify Katrina Heimbach at KHeimbach@BestCompaniesGroup.com immediately.
Checkout Options:
Option 1:
My organization is eligible for the free online survey. We do not need language translations, paper surveys nor do we wish to order the Employee Feedback Report at this time.

Submit my Free Registration

Option 2:
My organization needs paper surveys, language translations or wishes to order the Employee Feedback Report.
* Payment:
 Pay online now
Invoice me
Please note your registration will not go through if the verification code is entered incorrectly. In the event you enter the verification code incorrectly, or your browser times out, you will be directed back to the top of the registration form, with all of the fields blank. You can try hitting the F5 key to autofill the form, then re-check your information before submitting (please note this key function will not work with certain browsers).
In order to complete registration, please input the verification code as listed below. Once the code is entered, please click "Continue." Please note that the page will time out if you have had the page open for an extended period of time.
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