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GAIN Advanced Nuclear Directory Questionnaire-Supplier

GAIN Advanced Nuclear Directory - Supplier

Thank you for your interest in the GAIN Advanced Nuclear Directory. Please answer the following questions. All fields must be completed in order to submit the form. Answer "N/A" if the field does not have a response. 


Company Name *

Company Logo * (please upload a .png, .jpg, or .jpeg file type)

Company Website *

Please provide a company description/brief bio: *

Headquarters Location (City, State) *

Date Founded (Month, Year) *

Principal/CEO *

Major Customers: *

Federal Engagement (Check All that apply) *

If Other is selected, please specify

Preferred Point of Contact: (Name, email, and phone number) *

Additional Photos * - e.g., facility, schematics of technology, employees - (please upload a .png, .jpg, or .jpeg file type)

If you have any issues with the form please contact or