| |
| 1. | Do you wish to receive a FREE subscription to Medical Device Technology? |
Yes
No
Yes, please auto-fill my contact information for other publication qualification forms.
| 2. | What is your company's primary business? (select only one) |
| 3. | What is your job function? (select only one) |
| 4. | How many people are employed in your facility? (select only one) |
| 5. | Do you recommend, specify, or authorize the purchase of services, equipment, and supplies? |
Yes
No
| 6. | Which of the following products do you recommend, specify or purchase? (select all that apply) |
 |
| 7. | In order to verify your request for this subscription without the availability of your signature, the publisher's audit bureau requires that they ask a personal identifying question. This information is used SOLELY for the purpose of auditing your request. What is your day of birth? |
| | Would you like to receive EMAIL notices of other print or online publications, and other relevant offers from TradePub.com? |
Yes
No
| | Sign up for special offer alerts from select partners featuring the latest products and services you are interested in. |
Yes
No
| Related FREE Offers from TradePub.com: Check those you wish to receive. |
| | Which of the following best describes your industry? (select only one) |
Please specify for Other.
| | Which of the following is closest to your job function? (select only one) |
Please specify for Other.
| | What is the number of employees in your entire organization? (select only one) |
| | In addition to communications that may result from this inquiry, would you also like to receive news and event notifications from SAP that are specific to your interests? |
| |
Job Function: |
|
| |
Industry: |
|
| |
What is the approximate number of employees in your company? |
|
| |
Please check the one category that best describes your title: |
|
| |
Please indicate your primary type of institution/firm: |
|
| |
Number of beds in your organization: |
|
| |
How much will your organization spend on renovation/construction projects in the next 12 months? |
|
| |
In the performance of my job, I buy, specify and/or influence the purchase of the following products: (select all that apply) |
|
| |
For audit validation purposes, What month were you born? |
|
| |
Where is your primary business location? |
|
| |
|
| |
What are your pharmaceutical/biopharmaceutical manufacturing interests? (select all that apply) |
|
 |
| | Security Check: Enter both words below, separated by a space. |
|
|