Insurance & Technology Free Subscription

	*Insurance & Technology* is free to qualified professionals. Summary Description
	To apply for a FREE subscription to *Insurance & Technology*, 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

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2.	In lieu of a signature, we require a unique identifier used only for subscription verification purposes. How many siblings do you have?

3.	Do you approve or influence the purchase of technology products and/or services?

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

CORPORATE MANAGEMENT BUSINESS/DIV./DEPT./MGMT (cont.)

CEO/Chairman/President/Partner Head of Business Line

Chief Operating Officer IT MANAGEMENT

Chief Investment Officer/Chief Financial Officer Chief Information Officer

SENIOR MANAGEMENT Chief E-Business Officer

VP Chief Technology Officer

Director other than IS/IT Mgmt. VP/Director/Manager

Treasurer/Controller/Comptroller OTHER

BUSINESS/DIV./DEPT./MGMT Other Corporate/Senior/Business Management

CRM/Customer Service/Claims Other IT Management

Distribution/Delivery Channels IS/IT Staff

Finance/Accounting/Actuarial Other (please specify)

New Business/Product Development/Marketing

5.	Please indicate your firm's primary business: (select only one)

P&C Insurance Carrier Agency/Broker

Life/Health Insurance Carrier Life/Health Insurance Agency/Broker

Multi Line Insurance Carrier P&C Insurance Agency/Broker

Reinsurance Carrier Other (please specify)

6.	Your company's premium volume? (select only one)

More than $1 billion $25 - $99 million

$500 million - $1 billion Less than $25 million

$100 - $499 million

7.	How many employees are in your organization? (select only one)

20,000 or more 500 - 999

10,000 - 19,999 300 - 499

5,000 - 9,999 100 - 299

2,500 - 4,999 50 - 99

1,500 - 2,499 Less than 50

1,000 - 1,499

8.	Products Offered: (select only one)

All Lines Property & Casualty Insurance

Life Insurance Reinsurance

Health Insurance Other (please specify)

9.	What products are you planning to purchase in the next 6 months? (select all that apply)

Policy Management Systems Underwriting

CRM/Customer Support Security

E-Commerce/E-Business/Web Services Systems Integration

Hardware Telecom

Financial/Accounting/Payment Systems Networks

Services/Consulting Outsourcing

Claims None of the Above

10.

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