European Medical Device Manufacturer Free Subscription

	*European Medical Device Manufacturer* is free to qualified professionals. Summary Description
	To apply for a FREE subscription to *European Medical Device Manufacturer*, 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: Europe

1.	*Do you wish to receive a FREE subscription to European Medical Device Manufacturer?*

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:
Dept./Div.:
City:
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.)

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

2.	Please tick the category that best describes your company. (select only one)

Manufacturer of Finished Medical Devices Provider of Subcontracting Services

Manufacturer of In Vitro Diagnostics Manufacturing Consultant

Manufacturer of Dental Implants, Instruments and Systems Government/Academic

Manufacturer of Pharmaceuticals Others Allied to the Field (please specify)

3.	Please tick the category that best describes your job function. (select only one)

Product Design Engineering (including Product Design Engineering management)

Project Engineering (including Project Engineering Management)

Research and Development

Production/Manufacturing (including Production/Manufacturing Management)

Process Engineering (including Process Engineering Management)

Procurement/Specifying/Materials Management/Inventory Control

Quality Assurance/Quality Control

Regulatory/Legal Affairs

General/Corporate Management

Consultant

Other (please specify)

4.	How many employees in your company? (select only one)

1-24 100-249

25-99 250+

5.	Which of the following products do you recommend, specify, or purchase? (select all that apply)

Raw Materials (Non-plastics) Diagnostic Products

Plastics/Elastomers Filters

Adhesives Motors/Motion Control Products

Production Equipment/Services Pumps/Valves

Assembly Equipment/Services Sensors

Device-Coating/Surface-Treatment Equipment/Services Tubing and Fittings

Printing/Bar Coding Equipment/Services Electrical/Electronic Components

Testing Equipment/Services Computer Hardware/Software

Packaging Equipment/Services Cleanroom Products

Sterilization Equipment/Services Other (please specify)

6.	In order to verify your request for this subscription without the availability of your signature, our audit bureau requires that we ask a personal identifying question. This information is used SOLELY for the purpose of auditing your request. What are the color of your eyes?

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