Business Insurance Europe Free Subscription

	*Business Insurance Europe* is free to qualified professionals. Summary Description
	To apply for a FREE subscription to *Business Insurance Europe, 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 Europe*.
	The publisher determines qualification and reserves the right to limit the number of free subscriptions.
	Geographic Eligibility: Europe

1.	*Please start my free 3 month trial subscription to Business Insurance Europe.*

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)
Address:
Department/Division:
City:
State:
Zip Code/Postal Code:
Country:
	(Note: If your country is not listed above, subscriptions are not currently available at your location.)
Phone:
Fax:
Email:
	(Note: Valid email address is required or you could be disqualified.)

As a subscriber, you will receive regular email alerts and information from Business Insurance Europe. If you do not want to receive information by email please check here.

Which of the following best describes your industry? (select only one)

Please specify for Other:

Yes, please auto-fill my contact information for other publication qualification forms.

2.	Your level of seniority: (select only one)

Board Member (Owner, CEO, CFO, COO) Manager

Vice President Other (please specify)

Director/Department Head

3.	Please indicate which of the following best describes your Business/Industry: (select only one)

PURCHASERS SUPPLIERS

Manufacturing Insurance Agency

Agricultural Insurance Brokerage

Technology Consulting Firm

Construction Insurance Company

Transportation Reinsurance Company

Wholesale Trade Actuarial Firm

Retail Trade Law Firm

Service Business Adjusting/Appraisal Firm

Financial Institution Accounting Firm

Association Captive Management

Union Bank/Financial Institution

Government Third-Party Administration

Educational Institution Technology Providers

Other (please specify) Other (please specify)

4.	Number of person(s) employed by your organization: (select only one)

1 to 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 insurance and/or risk management: (select only one)

Recommend Approve/Authorize

Select I am a provider of these services

6.	For purposes of verification, what is the month in which you were born?

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