Nuclear Suppliers Association

INTERNET WEB SITE QUESTIONNAIRE

The following information is needed for your company's inclusion on the NSA Web Site (Please type or print legibly):

1. Company name (exactly as you wish it shown, including capitalization, periods, commas, etc.):

______________________________________________________________________________________

Address: _______________________________________________________________________________

______________________________________________________________________________________ ______________________________________________________________________________________

Phone No.:____________________________ FAX No.: ________________________

Name and Email Address (voting member, alternate or sales rep.) to be listed as Contact on "Company Information" page: _________________________________________________________________________________

Your company's Web site URL: _______________________________________________________

2. Please provide a brief discussion (optional) of your company's background, strengths, etc. for inclusion on the "Company Information" page -- not to exceed 150 words:

__________________________________________________________________________________________

Please check the products/services your company supplies that are relevant to your Nuclear Suppliers Association membership (If your products/services do not fit the exact descriptions, include them as "Other" under the broader category and provide a description.):

Radiation Protection Instruments and Supplies:
_____ In-plant Radiation Monitors

_____ Radiological Survey Instruments

_____ Personal Monitoring Devices

_____ Calibration Systems/Irradiators

_____ Shielding Materials

_____ Containment Tents/Glove Boxes

_____ Protective Clothing/Respirators

_____ Signs/Labels/Barrier Marking Materials

_____ Other

Trained Technologists for:
_____ Radiation Protection/ALARA Programs

_____ Training/Curriculum Development

_____ Emergency Preparedness Programs

_____ Radiation Safety Compliance

_____ Radwaste Handling/Decontamination

_____ Other

Manpower, Support Services and Equipment for:
_____ Nuclear Power Plant Outages/Refuelings

_____ Maintenance/Repairs

_____ Waste Management/Volume Reduction

_____ Material Packaging/Transportation

_____ System Audits/Analyses

_____ Outage Management/Cost Control

_____ Inspection Services

_____ Instrumentation and Controls

_____ Plant Modifications

_____ Other

4. Please list any other URLs you wish to have linked to the NSA Web site:

________________________________________________________________________
5. Name of person completing this form: _________________________________________

Date completed: _______________
Company: _______________________________________________________________