Medical Construction & Design Free Subscription

	*Medical Construction & Design* is free to qualified professionals. Summary Description
	To apply for a FREE subscription to *Medical Construction & Design*, 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

1.	*Do you wish to receive a FREE subscription to Medical Construction & Design?*

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First Name:
Last Name:
Job Title:
Company Name:
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Dept/Mail Stop/Suite:
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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.

2.	Please indicate your primary business/industry: (select only one)

Construction/General Contractor Supplier/Manufacturer

Engineering Government

Architecture Education

Interior Design Other (please specify)

Hospital/Health Care Facility

3.	Please indicate which best describes your title: (select only one)

Architect CFO, COO

Engineer Facility Manager

Interior Designer Vice President/Director

Project Manager Other (please specify)

Owner, President, CEO

4.	Which types of facilities do you or your firm work with? (select all that apply)

Hospitals University/Medical Schools

Surgery Centers Other (please specify)

Medical Office Buildings

Nursing Homes

5.	How much will your organization spend on renovation/construction projects in the next 12 months? (select only one)

Up to $1,000,000 $10 million - $24,999,999

$1 million - $4,999,999 $25 million - $100 million

$5 million - $9,999,999 More than $100 million

6.	In order to verify your request for this publication, without the availability of a signature our audit bureau requires that we ask a personal identifying question. This information is used solely for the purpose of auditing your request. Enter the last digit of the year you were born.

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If your firm is a contractor or consulting engineer firm, please check all activities in which your firm is involved: (select all that apply)

	Streets, Highways, Roads, Airport Pavements	Earthmoving, Excavating
	Bridges, Viaducts, Tunnels	Lighting, Signing or Safety
	Roadside Maintenance	None of the Above

Job Title: (select only one)

	Government Administrators - Mayor, City/Town/Village Manager, Administrator, Commissioner, Council Member, Director, Superintendent/Supervisor Public Works, Health, Service, Safety Officials, City/County/District Engineer, Clerk, Airport Manager, Engineer, other Government Administrator.
	Corporate Management - President, CEO, Chairman, Owner, Partner, Exec/Senior VP, VP, Secretary, Treasurer, Financial Officer, Purchasing Manager, Branch Manager, other Corporate Manager.
	Operations - General Manager, Director, VP, Manager (Area, Factory, Plant, Product, Division), Supt. of Streets, Highway/Road Supt., Project Engineer, Maint. Supt., Supervisor, Foreman, Operator, Chief Operator, Equipment Operator, other Operator.
	Engineering - Vice President, Director, Managing, Chief, Senior, Resident, Staff, Sanitary, Design, Mechanical, Architect, Estimator, Electrical, Chemical, Maintenance, Civil, Structural, Field, Construction, Environmental, EPA, Safety, Traffic, Highway, Road, Consulting, other Engineer.
	Technical - Research, Scientist, Biologist, Chemist, Analyst, Environmental and Pollution Control Spec., Tech. Mgr., Supt. Supv., Foreman, other Technician.
	Marketing & Sales - Manager of Marketing/Sales, other Sales/Marketing Person.
	Other
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In order to verify your on-line subscription request, Scranton Gillette Communications is required to ask a personal identifying question. This information is used SOLELY for the purpose of auditing your request. What day of the month were you born?

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