= Required
Personal Information
First Name:
Last Name:
Prefix:
Mr.
Ms.
Mrs.
Miss
Home Contact Information
Address (Street):
City:
Province/State:
AB - Alberta
BC - British Columbia
MB - Manitoba
NB - New Brunswick
NF - Newfoundland
NS - Nova Scotia
NT - N.W. Territories
NU - Nunvut
ON - Ontario
PEI - Prince Edward Island
QC - Quebec
SK - Saskatchewan
YK - Yukon
AK - ALASKA
AL - ALABAMA
AR - ARKANSAS
AS - AMERICAN SAMOA
AZ - ARIZONA
CA - CALIFORNIA
CO - COLORADO
CT - CONNECTICUT
DC - DISTRICT OF COLUMBIA
DE - DELAWARE
FL - FLORIDA
FM - FEDERATED STATES OF MICRONESIA
GA - GEORGIA
GU - GUAM
HI - HAWAII
IA - IOWA
ID - IDAHO
IL - ILLINOIS
IN - INDIANA
KS - KANSAS
KY - KENTUCKY
LA - LOUISIANA
MA - MASSACHUSETTS
MD - MARYLAND
ME - MAINE
MH - MARSHALL ISLANDS
MI - MICHIGAN
MN - MINNESOTA
MO - MISSOURI
MP - NORTHERN MARIANA ISLANDS
MS - MISSISSIPPI
MT - MONTANA
NC - NORTH CAROLINA
ND - NORTH DAKOTA
NE - NEBRASKA
NH - NEW HAMPSHIRE
NJ - NEW JERSEY
NM - NEW MEXICO
NV - NEVADA
NY - NEW YORK
OH - OHIO
OK - OKLAHOMA
OR - OREGON
PA - PENNSYLVANIA
PR - PUERTO RICO
PW - PALAU
RI - RHODE ISLAND
SC - SOUTH CAROLINA
SD - SOUTH DAKOTA
TN - TENNESSEE
TX - TEXAS
UT - UTAH
VA - VIRGINIA
VI - VIRGIN ISLANDS
VT - VERMONT
WA - WASHINGTON
WI - WISCONSIN
WV - WEST VIRGINIA
WY - WYOMING
Postal/Zip Code:
Country:
Canada
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Ashmore and Cartier Islands
Australia
Austria
Azerbaijan
Bahamas, The
Bahrain
Baker Island
Bangladesh
Barbados
Bassas da India
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
British Virgin Islands
Brunei
Bulgaria
Burkina Faso
Burma
Burundi
Cambodia
Cameroon
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Clipperton Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Coral Sea Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Europa Island
Falkland Islands (Islas Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern and Antarctic Lands
Gabon
Gambia, The
Gaza Strip
Georgia
Germany
Ghana
Gibraltar
Glorioso Islands
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See (Vatican City)
Honduras
Hong Kong
Howland Island
Hungary
Iceland
India
Indian Ocean
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Jan Mayen
Japan
Jarvis Island
Jersey
Johnston Atoll
Jordan
Juan de Nova Island
Kazakhstan
Kenya
Kingman Reef
Kiribati
Korea, North
Korea, South
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia, The Former Yugoslav Republic of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Man, Isle of
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States of
Midway Islands
Moldova
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Namibia
Nauru
Navassa Island
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palmyra Atoll
Panama
Papua New Guinea
Paracel Islands
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russia
Rwanda
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
Spain
Spratly Islands
Sri Lanka
Sudan
Suriname
Svalbard
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tokelau
Tonga
Trinidad and Tobago
Tromelin Island
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands
Wake Island
Wallis and Futuna
West Bank
Western Sahara
Yemen
Zambia
State/Region (If outside North America):
Home Phone Number:
Work Contact Information
Company/Organization Name:
Position:
Address (Street):
City:
Province/State:
AB - Alberta
BC - British Columbia
MB - Manitoba
NB - New Brunswick
NF - Newfoundland
NS - Nova Scotia
NT - N.W. Territories
NU - Nunvut
ON - Ontario
PEI - Prince Edward Island
QC - Quebec
SK - Saskatchewan
YK - Yukon
AK - ALASKA
AL - ALABAMA
AR - ARKANSAS
AS - AMERICAN SAMOA
AZ - ARIZONA
CA - CALIFORNIA
CO - COLORADO
CT - CONNECTICUT
DC - DISTRICT OF COLUMBIA
DE - DELAWARE
FL - FLORIDA
FM - FEDERATED STATES OF MICRONESIA
GA - GEORGIA
GU - GUAM
HI - HAWAII
IA - IOWA
ID - IDAHO
IL - ILLINOIS
IN - INDIANA
KS - KANSAS
KY - KENTUCKY
LA - LOUISIANA
MA - MASSACHUSETTS
MD - MARYLAND
ME - MAINE
MH - MARSHALL ISLANDS
MI - MICHIGAN
MN - MINNESOTA
MO - MISSOURI
MP - NORTHERN MARIANA ISLANDS
MS - MISSISSIPPI
MT - MONTANA
NC - NORTH CAROLINA
ND - NORTH DAKOTA
NE - NEBRASKA
NH - NEW HAMPSHIRE
NJ - NEW JERSEY
NM - NEW MEXICO
NV - NEVADA
NY - NEW YORK
OH - OHIO
OK - OKLAHOMA
OR - OREGON
PA - PENNSYLVANIA
PR - PUERTO RICO
PW - PALAU
RI - RHODE ISLAND
SC - SOUTH CAROLINA
SD - SOUTH DAKOTA
TN - TENNESSEE
TX - TEXAS
UT - UTAH
VA - VIRGINIA
VI - VIRGIN ISLANDS
VT - VERMONT
WA - WASHINGTON
WI - WISCONSIN
WV - WEST VIRGINIA
WY - WYOMING
Postal/Zip Code:
Country:
Canada
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Ashmore and Cartier Islands
Australia
Austria
Azerbaijan
Bahamas, The
Bahrain
Baker Island
Bangladesh
Barbados
Bassas da India
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
British Virgin Islands
Brunei
Bulgaria
Burkina Faso
Burma
Burundi
Cambodia
Cameroon
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Clipperton Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Coral Sea Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Europa Island
Falkland Islands (Islas Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern and Antarctic Lands
Gabon
Gambia, The
Gaza Strip
Georgia
Germany
Ghana
Gibraltar
Glorioso Islands
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See (Vatican City)
Honduras
Hong Kong
Howland Island
Hungary
Iceland
India
Indian Ocean
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Jan Mayen
Japan
Jarvis Island
Jersey
Johnston Atoll
Jordan
Juan de Nova Island
Kazakhstan
Kenya
Kingman Reef
Kiribati
Korea, North
Korea, South
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia, The Former Yugoslav Republic of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Man, Isle of
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States of
Midway Islands
Moldova
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Namibia
Nauru
Navassa Island
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palmyra Atoll
Panama
Papua New Guinea
Paracel Islands
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russia
Rwanda
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
Spain
Spratly Islands
Sri Lanka
Sudan
Suriname
Svalbard
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tokelau
Tonga
Trinidad and Tobago
Tromelin Island
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands
Wake Island
Wallis and Futuna
West Bank
Western Sahara
Yemen
Zambia
State/Region (If outside North America):
Work Phone Number:
Mobile Phone/ Pager:
Fax Number:
E-Mail
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Home E-Mail Address:
Work E-Mail Address:
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Validation
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Please take a moment to complete the following eight question survey (or scroll down to click submit)
1. How did you become aware of the Logistics Institute? (select all that apply )
2. What factors or features influenced your decision to make us your logistics learning organization of choice? (Select all that apply )
Factors
The Logistics Institute's reputation
P.Log. designation
Value for price
Friend/ Colleague recommendation
Discussion with a Logistics Institute representative
Advertising
Corporate Member discount
Features
Duration of P.Log. program
Flexibility of P.Log. program
Web-delivery of certain modules
3. Which of the following best describes your goals as a student of the Logistics Institute? (Select all that apply )
Obtain the P.Log. designation
Learn new skills and abilities
Upgrade/ maintain existing skills and abilities
Network with peers
4. Please indicate your age range:
5. Gender:
6. Annual Income:
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$20,000-$29,999
$30,000-$39,999
$40,000-$49,999
$50,000-$59,999
$60,000-$69,999
$70,000-$74,999
$75,000-$99,999
$90,000-$99,999
$100,000-149,999
$150,000 & over
7. Level of Education (check highest level completed ):
8. Degrees/ Designations earned: (e.g. B.A., M.A., Ph.D, CITT, P.Eng. )
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