1.	Do you wish to receive a FREE subscription to OR NURSE 2008?

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)
Address:
Department/Mail Stop:
City:
State/Province:	Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming   American Samoa Guam Marshall Islands Micronesia (Federated States of) Palau Puerto Rico U.S. Minor Outlying Islands U.S. Virgin Islands Northern Mariana Islands Armed Forces Americas AA Armed Forces Middle East, Europe, Canada AE Armed Forces Pacific AP   Other
Zip:
Country:	USA OTHER
	(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)

Select Number of Employees Less than 50 50-99 100-499 500-999 1,000-4,999 5,000-9,999 Greater than 10,000

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

2.	My title is: (select only one)

RN	CRNA
LPN/LVN	Other (please specify)
Nurse Practitioner
Clinical Nurse Specialist

3.	You work in a: (select only one)

Hospital	Other (please specify)
Ambulatory (In-Hospital)
Ambulatory (Free Standing/Surgicenter)

4.	Your title or Position is: (select only one)

VP/CNO	Nursing Faculty
Director/Administrator of Nursing Service	RN-First Assistant (RFNA)
Nurse Manager	Private Scrub Nurse
RN-Staff Nurse	Other (please specify)
Staff Development Education

5.	I am a perioperative nurse and my practice areas are: (check up to three)

General Surgery	Pediatrics
Cardiothoracic	Podiatry
Orthopedic	Central Processing
Vascular	Pre-Admission
Endoscopy	Purchasing
OB/LDRP//NICU	Infection Control
Neurosurgery	Oncology
Plastic/Reconstructive	Trauma
Laproscopy	Critical Care (ICU/CCU)
Laser	Emergency Dept
PACU	Rehab
Anesthesia	Computer/Informatics
Urology	Other Nursing Service (please specify)
Opthalmology
Otorhinolaryngology - ENT

6.	In lieu of a signature, we require a unique identifier used only for subscription verification purposes. What month were you born in?

Select month born January February March April May June July August September October November December

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

Yes     No

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

Yes     No

Project Management and Collaboration Tools for Business Teams - Central Desktop's Award Winning project & collaboration platform serves more than 150,000 users worldwide. Perfect for small business teams or workgroups in large companies. Create secure online workspaces to coordinate and manage projects. Easily share files and collaborate on documents, track projects, manage tasks and share calendars. Get started in minutes without the IT hassle. Free 30-day trial and 25% discount for TradePub Subscribers. Note: Offer Valid in the United States and Canada Only.

4 FREE Trial ISSUES OFFER OF The Economist! Insights on the world, weekly. The Economist is a global weekly magazine written and edited for readers who share an uncommon interest in being well and broadly informed. With objective authority, clarity and wit, The Economist presents well-considered analysis of the world's business, political, scientific, technological and cultural affairs and the connections between them. Subscribe to The Economist today and you'll get 4 RISK-FREE issues as a free trial. If you wish to continue your subscription, you'll receive 20 additional issues - 24 in all for just $2.49 an issue (total of $59.76). That's 58% off the cover price. If you decide The Economist is not for you, write 'cancel' on the bill, return it and owe nothing. Note: Offer Valid in the United States Only.

Request your Free Trial today! Try MyFax™ FREE for 30 days. Rated #1 by TopTenREVIEWS three years in a row, MyFax is an Internet fax service that lets you send and receive faxes from your email or the web. No software, hardware, second phone line, or long distance charges! Fax to any fax machine worldwide and never miss a fax again! MyFax is reliable - always on and never busy or out of paper. Note: Offer Valid in the United States and Canada Only.

Discover how to find new customers online. Spot Runner brings you new prospects with Online Advertising. We put your business on major search engines like Google, Yahoo, and create you a free video for sites like YouTube! Click to learn more about Spot Runner's Online Advertising solution today! Note: Offer Valid in the United States Only.