WaterWorld Free Subscription

	*WaterWorld* is free to qualified professionals. Summary Description
	To apply for a FREE subscription to *WaterWorld*, please answer ALL of the questions on the form below.
	The magazine publisher determines qualification and reserves the right to limit the number of free subscriptions.
	Geographic Eligibility: USA, Canada

1.	*Do you wish to receive a FREE subscription to WaterWorld?*

Yes No

2.	How would you like to receive your issues?

Print Digital (email address required for digital delivery)

First Name:
Last Name:
Job Title:
	(Ex: Director, Vice President, Project Manager, etc.)
Company:
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Street Address:
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City:
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Email Address:
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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.

3.	What is the nature of your organization? (select only one)

Water and Wastewater Systems and/or Plants Federal Agencies (incl. EPA), State Agencies, Public Health Agencies

Water Only Systems and/or Plants Educational Institutions

Wastewater Only Systems and/or Plants Research or Analytical Laboratories

Consulting Firms (incl. Engineering, Contracting & Environmental) Manufacturers or Distributors of Equipment & Supplies (incl. Reps)

Industrial Water/Wastewater Facilities or Water Wholesalers Others allied to the field (please specify)

4.	This location or facility is: (select only one)

Municipally Owned & Operated Municipally Owned/Investor Operated

Investor Owned & Operated Other (please specify)

5.	What is your job title? (select only one)

Executive/Administrative Management (i.e. President, Vice President, Board Member, Mayor, Owner, etc.)

Engineering & Operations Management (i.e. Division Head, General Manager, Superintendent, Section Head, Department Head, Chief Engineer, etc.)

Engineering & Design Staff (i.e. Consulting Engineer, Civil Engineer, Mechanical Engineer, Environmental Engineer, Electrical Engineer, Planning Engineer, System Designer, etc.)

Scientific & Research (i.e. Chemist, Biologist, Biophysicist, Analyst, Lab Technician, etc.)

Operations (i.e. Foreman, Plant Operator, Maintenance Crewman, Service Representative, Collection Systems, etc.)

Purchasing/Marketing/Sales (i.e. Purchasing, Market Representative, Salesperson, Sales Representative, Market Analyst, etc.)

Other (please specify)

6.	What is the population served by your water system: (select only one)

500 or less 10,001 - 100,000

501 - 3,300 Greater than 100,000

3,301 - 10,000 None/not applicable

7.	Please check below all products and systems that you recommend, specify, purchase or approve purchase. (select all that apply)

Aeration Process Control Equipment

Chemicals/Biochemicals Pumps, Valves, Seals, Packing & Related Products

Corrosion Control Safety Equipment

Computers/Software Sampling & Analyzing Equipment & Instrumentation

Customer Information Systems SCADA (Supervisory Control & Data Acquisition)

Detectors, Monitors, Recorders Security Equipment, Systems

Disinfection Equipment Sludge Dewatering & Processing Equipment

Engineering & Construction Services Sludge Processing & Application

Filtration Equipment Stormwater Equipment & Services

Flow, Pressure & Level Measuring Equipment & Accessories Tanks & Structures

Groundwater Treatment Trenchless Equipment & Technology

Laboratory Equipment, Supplies & Services Water Treatment Equipment

Membranes Wastewater Treatment Equipment

Meters & Meter Reading Equipment Water Well Drilling, Maintenance & Monitoring

Odor Control None of the above

Pipes, Fitting & Related Products

8.	In lieu of a signature, we require a personal identifier. To verify that you submitted this application please select the first letter of the city where you were born.

What is the first letter of the city where you were born?

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