Food Product Design Free Subscription

	*Food Product Design* is free to qualified professionals. Summary Description
	To apply for a FREE subscription to *Food Product Design*, 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: USA, Canada

1.	*Do you wish to receive a FREE subscription to Food Product Design?*

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:
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.)

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

2.	What is your company's primary business? (select only one)

Prepared Foods Bakery Products

Food Service, Fast Food, QSR Bread, Cakes & Related Products

Prepared Dinners, Meals, Side Dishes Cookies and Crackers

Frozen Specialties, Dinners Other Bakery Products

Meat Confectionery

Sausages/ Other Prepared Meats Candy & Confectionary

Poultry Processing Chocolate & Cocoa Products

Other Meat Products Chewing Gum

Dairy Other Confectionary Products

Creamery Butter Beverages

Cheese, Natural & Processed Malt Beverages

Condensed & Evaporated Milk Wines, Brandy & Brandy Spirits

Ice Cream & Frozen Desserts Distilled & Blended Liquor

Fluid Milk Bottled & Canned Soft Drinks

Other Dairy Products Flavoring Extracts & Syrups n.e.c.

Preserved Fruits & Vegetables Other Beverage Products

Canned Specialties Other Food Products

Canned Fruits & Vegetables Seafood Canned & Cured

Dehydrated Fruits, Veg, Soups Seafood Prepared Fresh/ Frozen

Pickles, Sauces, Salad Dressings Coffee Roasted/ Flavored

Frozen Fruits & Vegetables Potato Chips, Corn Chips & Snacks

Other Fruits & Vegetables Macaroni, Spaghetti, Noodles

Grain Mill Nuts & Seeds Salted/ Roasted

Flour, Dough, Prepared, Blended Shortening & Cooking Oil

Cereal Breakfast Foods Processed Food Ingredients

Dog, Cat & Other Pet Foods Other Food Prod & Food Preparations (please specify)

Prepared Feeds n.e.c.

Other Grain Mill Products

3.	What is your job title? (select only one)

Research & Development Corporate Management cont.

VP Research & Development Executive VP

Director of Research COO

Technical Director General Manager

Quality Control Other Corporate Management

Technical Service Director Sales & Marketing

Laboratory Director VP of Marketing & Sales

Technician Director/ Manager of Marketing Sales/ Advertising

Chemist/ Scientist Product/ Brand Manager

Food Technologist Other Sales & Marketing

Product Developer Purchasing

Professor/Instructor VP of Purchasing

Other Product Development Procurement Manager

Corporate Management Purchasing Agents/ Buyers

President Other Purchasing

Owner Other Titled & Non-Titled

Corporate Official Other (please specify)

Partner

4.	How many employees work at this location? (select only one)

1 to 19 100 to 499

20 to 99 500 or more

5.	For which of the following applications are your products/services used? (select only one)

Retail Other (please specify)

Food Service

6.	Do you plan to introduce a new product or expand an existing product line in the next 24 months?

Yes No

7.	Which of the following products do you buy, specify, recommend or influence the purchase of for your company? (select all that apply)

Ingredients Packaging Materials and/or Equipment

Nutritional Ingredients QA/QC Instrumentation & Software

Flavors None of the above

8.	In the performance of your job, in which of the following functions are you involved? (select all that apply)

Research & Development Purchasing

New Product Development Marketing

Food Service Product Development None of the above

Lab Management/QA/QC

9.	In order to permit future verifications of your request for a free subscription, we need to ask you a personal identifier. What state were you born in?

10.

Please select whether or not you would like to receive the Food Product Design e-newsletter.

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