Business Insurance
  Business Insurance is free to qualified professionals. Summary Description
  To apply for a FREE subscription to Business Insurance, please answer ALL of the questions on the form below.If you qualify, you'll receive a free, 3 month trial subscription to Business Insurance.
  The publisher determines qualification and reserves the right to limit the number of free subscriptions.
  Geographic Eligibility: USA


 
1. Please start my free 3 month trial subscription to Business Insurance.
Yes     No


First Name:
Last Name:
Job Title:
(Ex: Director, Vice President, Project Manager, etc.)
Company:
(Please provide your Company Name in full: abbreviations could disqualify you)
Street Address:
Suite/Floor:
City:
State:
Zip:
Country:
(Note: If your country is not listed above, subscriptions are not currently available at your location.)
Phone:
Fax:
Email Address:
(Note: Valid email address is required or you could be disqualified.)
As a subscriber to Business Insurance, you will also receive BI Daily News Alert and This Week in BI email products. I do not wish to receive:

BI Daily News Alert
This Week in BI
I prefer not to receive information on advertising from companies not affiliated with Business Insurance.
 
Yes, please auto-fill my contact information for other publication qualification forms.


2. Please indicate which of the following best describes your title or job function? (select only one)
CEO/COO/President/Owner VP/GM/Dir/Mgr of: Health and/or Group Insurance
CFO/VP of Finance VP/GM/Dir/Mgr of: Pensions & Profit Sharing/Compensation
Controller/Secretary/Treasurer VP/GM/Dir/Mgr of: Corporate Management
Financial title other than CFO Accountant
General Counsel/Attorney Actuary, Adjuster, Appraiser
VP/GM/Dir/Mgr of: Risk Management Captive Manager
VP/GM/Dir/Mgr of: Employee Benefits/Human Resources Insurance Agent/Broker, Intermediary
VP/GM/Dir/Mgr of: Insurance/Property Casualty Insurance Underwriter, Insurer
VP/GM/Dir/Mgr of: Claims Other Adminstrative Titles
VP/GM/Dir/Mgr of: Workers Compensation Other (please specify)
VP/GM/Dir/Mgr of: Safety & Security


3. Please indicate which of the following best describes your business/industry? (select only one)
Accounting Firms Insurance and Reinsurance Companies
Actuarial/Adjuster/Appraiser Firm Law Firms
Association Manufacturing/Service Firms
Captive Management Technology
Financial Claims/Third-Party Administration
Government/Union/Educational Institution Other (please specify)
Health Care Provider
Insurance Agency, Brokerage, Consulting Firm


4. Number of persons employed by your organization: (select only one)
1 - 150 1,000 - 4,999
151 - 499 5,000 or more
500 - 999 Unknown


5. Please indicate the extent to which you are involved in the purchasing decision for your employer's risk management and/or employee benefits products and services: (select only one)
Highly Involved Not Involved
Somewhat Involved I am a provider of these services


6. For purposes of verification, please provide the state you were born in:


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