Healthcare Packaging Free Subscription

	*Healthcare Packaging* is free to qualified professionals. Summary Description
	To apply for a FREE subscription to *Healthcare Packaging*, 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, Mexico

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

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

What is the approximate number of employees in your company? (select only one)

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

2.	What is your primary product manufactured or service performed at your location? (select only one)

Pharmaceuticals Validation, Compliance, Regulatory Affairs

Medical Devices/Diagnostic Instruments Integration Services/Line Automation

Nutraceuticals, Vitamins, or Dietary Supplements Other (please specify)

Contract Manufacturer/Packager

Biological/Biopharmaceutical

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

Corporate & General Management Package Design

Production & Engineering Purchasing

QA/QC Regulatory Affairs

Marketing Global Security/Corporate Brand Protection

Research and Development Other (please specify)

4.	What is the total number of employees at your location? (select only one)

Under 20 250 - 499

20 - 49 500 - 999

50 - 99 1000 or more

100 - 249

5.	In which regions of the world does your company operate? (select all that apply)

Asia Pacific including Australia North America

Europe including Russia Africa including Middle East

Latin America

6.	In lieu of a signature, we require a personal identifier. To verify that you submitted this application please specify the name of the high school you attended. What is the name of the high school you attended?

Would you like to receive EMAIL notices of other print or online publications, and other relevant offers from TradePub.com?

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* The publisher reserves the right to limit the number of free subscriptions and/or reject requests based on information provided.