Infection Control Today Free Subscription

	*Infection Control Today* is free to qualified professionals. Summary Description
	To apply for a FREE subscription to *Infection Control Today*, 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 Infection Control Today?*

Yes No

2.	Please select the preferred format: (select only one)

Print Version of Infection Control Today only
Digital Version of Infection Control Today only
Both the Print and Digital Versions of Infection Control Today

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:
Dept/Div:
City:
State:
Zip:
Country:
	(Note: If your country is not listed above, subscriptions are not currently available at your location.)
Phone:
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)

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

3.	Which of the following best represents the primary business of the company with whom you are employed? (select only one)

Hospital: Infection Control SurgiCenter: OR/Surgery

Hospital: OR/Surgery SurgiCenter: Nursing

Hospital: Sterile Processing/CS/SPD SurgiCenter: Materials Management/Purchasing

Hospital: Nursing SurgiCenter: Administration

Hospital: Materials Management/Purchasing Nursing Home/Rehab: Nursing

Hospital: Administration Nursing Home/Rehab: Admin./Purchasing

Hospital: Environmental Services/House Keeping University: Medical Library

Hospital: GI Lab Group Purchasing: Administration

Hospital: Inservice Education Other Healthcare

Hospital: Medical Library Not a Healthcare Provider

Hospital: Other Other (please specify)

4.	Which of the following best describes your title? (select only one)

Manager/ Director/ Department Head Administrator/ President/Vice President

Assistant Manager/ Assistant Director Library Director/ Librarian

Supervisor/ Coordinator Technician

Nurse/ Practitioner Other (please specify)

Buyer/ Agent

CEO/ CFO/ CIO/ COO/ CMP/ CPO

5.	What is your facility's average bed size? (select only one)

1 to 99 400 to 499

100 to 199 500 & Above

200 to 299 Non Hospital

300 to 399

6.	What is your role in purchasing decisions? (select only one)

Full Responsibility Specify or Recommend Member of Product Evaluation Committee

7.	Are you on a product evaluation committee?

Yes No

8.	In order to permit future verifications of your request for a free subscription, we need to ask you a personal identifier. What state were you born in?

9.	*Please select whether or not you would like to receive the Infection Control Today* e-newsletter.**

Yes No

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

Security Check: Enter both words below, separated by a space.

* Note that a valid email address is required to fulfill your request. Please verify that the email and mailing address you provided are accurate before hitting the submit button.

* The publisher reserves the right to limit the number of free subscriptions and/or reject requests based on information provided.