Medical Marketing & Media Free Subscription

	*Medical Marketing & Media* is free to qualified professionals. Summary Description
	To apply for a FREE subscription to *Medical Marketing & Media*, 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 Marketing & Media?*

Yes No

First Name:
Last Name:
Title:
	(Ex: Director, Test Lead, Project Manager, etc.)
Company:
	(Please provide your Company Name in full: abbreviations could disqualify you)
Street Address:
Suite/Floor/MS:
City:
State:
Zip:
Country:
	(Note: If your country is not listed above, distribution is not currently available at your location.)
Email Address:
	(Note: Valid email address is required or you could be disqualified.)
Phone:
Fax:

Check here if you would like to receive information about Haymarket's Pharmaceutical Marketers Directory.

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

2.	In lieu of a signature, we require a unique identifier used only for subscription purposes. What is the name of the school you last attended?

3.	Type of Company: (select only one)

Healthcare Manufacturer - Pharmaceutical Creative/Design/DM Firm

Healthcare Manufacturer - Device, Diagnostic Equipment and Product Consultants

Ad Agency Other Service/Support Company (including PR firms, Government Agency, R&D, Universities, Libraries)

Publisher/Publishers Rep Other (please specify)

Continuing Medical Education (CME)

Market Research Firm

4.	If a Healthcare Manufacturer please indicate all types of products you are involved with. (select all that apply)

RX/Ethical Pharmaceuticals Hospital Products/Equipment

OTC/Consumer/Proprietary Dental Products/Equipment

Medical Products/Equipment Biotechnology

Diagnostic Products/Equipment Other

5.	Job Function: (select only one)

General Management Market Research

Marketing/Advertising Mgmt R&D Management

Product/Brand/Category Mgmt or Agency Account Mgmt Creative/Production/Traffic

Sales Management Public Relations or Regulatory Affairs

Promotion Management Library

Media Other (please specify)

6.	Do you determine, evaluate, recommend, specify or approve the purchase of services/products for your department or company?

Yes No

7.	Please estimate the number of employees in your entire company: (select only one)

1 - 25 100 - 249

26 - 49 250 - 499

50 - 99 500 +

8.	What is your approximate annual budget for media/marketing expenditures? (select only one)

0 - $50,000 $1 Million - $10 Million

$50,001 - $250,000 $10 Million +

$250,001 - $1 million

9.	Which of the following business publications do you read? (select only one)

Med Ad News Healthcare Marketers Exchange

Pharmaceutical Executive None of the Above

Pharma Voice Other (please specify)

DTC Perspectives

Product Management Today

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

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Would you like to receive relevant information from TradePub.com on behalf of third party businesses/organizations?

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