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  Contact Doug
Thank you for filling in all the requested items.
 
  Doug's Information Request Form
Location and Duration  
 
Full opportunity description  
 
Rate  
 , per Hour Day Week Month Annual All inclusive
* NOTE:
The rate is negotiable based on many factors, including contract length, required travel, W@ / 1099, benefits...
Includes Per Diem  
  Yes No [Check One]
Required Travel  
  None, 0-25%, 25-50%, 50-75%, or Road Warrior [Check One]
Your Name  
 
I will use this name in our correspondence.
Your Company Name  
 
Your E-Mail Address  
  I will contact you via this email address.
Your Postal Address  
 
Your City, State, Zip  
 
Your primary phone number  
 
Your secondary phone number  
 
Other helpful information  
 
 
~ Contact Douglas E. Lee ~ All data has been redacted ~