Medical Laboratory Observer Free Subscription

	*Medical Laboratory Observer* is free to qualified professionals. Summary Description
	To apply for a FREE subscription to *Medical Laboratory Observer*, 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

1.	*Do you wish to receive a FREE subscription to Medical Laboratory Observer?*

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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)
Address:
Mail Stop/Dept:
City:
State:
Zip:
Country:
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Phone:
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Email Address:
	(Note: Valid email address is required or you could be disqualified.)

Yes, I would like to receive MLO's monthly email newsletter, LABLINE.

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.	For auditing purposes, please enter the high school you last attended: (Provide last school attended if high school does not apply.)

3.	Please select the type of laboratory and/or facility: (select only one)

Hospital Lab - Private Blood Bank

Hospital Lab - VA Medical School/Med Tech/CLS Ed Programs

Hospital Lab - Military Biomedical Industrial Lab

Hospital Lab - Public Health Free Standing Emergency Ctr/Ambulatory Care Ctr

Hospital Lab - State/County/City Group Purchasing Organization

Hospital Lab - University/Teaching HMO/PPO

Hospital Lab - Other Physicians Office Laboratory

Independent Lab Other (please specify)

Group Practice Lab

Gov't/Public Health Lab (non-hospital)

4.	Please select your primary job function: (select only one)

Pathologist Group Practice Mgr/Administrator

Lab Director Lab Info Systems Manager

Lab Manager/Administrator/Supervisor Education Coordinator

Chief Medical Technologist Nurse Laboratorian

Assist Chief Medical Technologist Owner/Officer/Purchasing

Hospital Administrator Clinical Researcher

Clinical Chemist POL Director

Microbiologist Other(please specify)

Physician

5.	Number of beds in your organization: (select only one)

0 - 25 200 - 299

26 - 49 300 - 399

50 - 99 400 - 499

100 - 199 500+

6.	Please indicate the annual volume of testing performed by your lab: (select only one)

Less than 2,000 50,001 - 75,000

2,000 - 10,000 75,001 - 100,000

10,001 - 25,000 100,001 - 500,000

25,001 - 50,000 500,001 - 1,000,000

7.	Please check all areas for which you have purchasing involvement: (select all that apply)

Barcode/Patient ID Systems Centrifuges

Blood Collection Devices Chemistry Analyzers/Instruments

Certification and Education Programs Coagulation Analyzers

Chemistry, Reagents and Test Kits Cytology/Histology, Tests and Instruments

Coagulation, Reagents and Test Kits Diagnostic Testing Services

Diagnostic Equipment and Instruments Employment/Staffing Services

Disinfectants and Sterilants Genetic Testing, Reagents, Test Kits, and Instruments

Flow Cytometry Instruments and Test Kits Hematology, Reagents, Test Kits, and Controls

Hematology Analyzers Infectious Disease, Test Kits

Imaging Systems Lab Furniture and Lighting

Lab Automation Systems (Software) Microbiology, Media, Reagents, Test Kits/Instruments

Laboratory Info Systems Molecular Biology, Reagents, Test Kits/Instruments

Microscopes/Digital Cameras Protective Apparel/Gloves

Point-Of-Care Testing Reference Lab Testing Services

Rapid Tests Safety Products

Refrigerators/Chillers Specimen Collection Needles/Tubes/Containers/Identification Products

Slide Markers and Strainers Urinalysis,

Specimen Transport Water Purification Systems

Waste Management and Disposal Products None of the Above

Blood Bank Supplies

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