eClip Free Subscription

	*eClip* is free to qualified professionals. Summary Description
	To apply for a FREE subscription to *eClip*, please answer ALL of the questions on the form below.
	The publisher determines qualification and reserves the right to limit the number of free subscriptions.
	Geographic Eligibility: Worldwide

1.	*Do you wish to receive a FREE subscription to eClip?*

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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:
Department/Mail Stop:
City:
State:
Zip/Postal Code:
Country:
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Business Phone:
Business Fax:
Email Address:
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Yes, please auto-fill my contact information for other publication qualification forms.

Which of the following is closest to your job function? (select only one)

Please specify for Other:

2.	What is the primary product packaged at your location or your company's primary packaged product? (select only one)

A. FOOD AND BEVERAGE PRODUCTS B. HEALTHCARE/PERSONAL CARE/CHEMICAL (cont.)

Meat, Poultry, Seafood Nutraceutical, Vitamin, Dietary Supplement

Fruits, Vegetables (Fresh, Canned Frozen) Government

Grains, Seeds, Beans, Flour, Nuts C. OTHER PACKAGED PRODUCTS

Cereals, Breakfast Foods Apparel, Textiles

Baked Goods, Cookies, Crackers, Pasta, Snack Foods Consumer Electronics, Computers, Peripherals, Household Appliances

Confectionary Products, Sugar Toys, Games, Sporting Goods

Dairy Products Plastic, Rubber Products

Beverages (Soft Drinks, Juices, Alcoholic Beverages, Coffee, Tea) Paper, Printed Products, Office Supplies

Soups, Sauces, Condiments, Dressings, Spices, Syrup, Powders Metal Glass, Wood Products

Fats, Oils Machinery, Electronic

Pet Foods, Animal Foods Other Packaged Products

Other Food and Beverage Products Food Stores, Food Service

B. HEALTHCARE/PERSONAL CARE/CHEMICAL Wholesalers, Distributors, Warehouses

Cosmetics, Toiletries, Baby Products Contract Packager

Soap, Household Cleaners, Other Household Products Package Design Firm

Chemicals, Paints, Adhesives Packaging Machinery

Pharmaceutical Other Products Or Services (please specify)

Medical Devices/Diagnostic Instruments

3.	Number of employees at this location? (select only one)

1 - 19 250 - 499

20 - 49 500 - 999

50 - 99 1000+

100 - 249

4.	What are your job duties? (select only one)

General Management Trafficking

Production QA/ QC

Marketing Regulatory Affairs

Research & Development Other

Package Design

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