CircuiTree Free Subscription

	*CircuiTree* is free to qualified professionals. Summary Description
	To apply for a FREE subscription to *CircuiTree*, 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 (Print or Digital Edition), International (Digital Edition Only)

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

Yes No

2.	Please check your preferred format:

Print Version of CircuiTree (USA and Canada only) Digital Version of CircuiTree (USA and International)

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)
Street Address:
Department/Mail Stop:
City:
State/Province:
Zip/Postal Code:
Country:
	(Note: If your country is not listed above, subscriptions are not currently available at your location.)
Email Address:
	(Note: Valid email address is required or you could be disqualified.)
Business Phone:
Business Fax:
	You will receive subscription and renewal notices from BNP Media via email.

3.	Optional: If you want delivery to your home or Business P.O. Box, please complete the area below.

Please mail my copy to: Home (below) P.O. Box (below) Business Address (above)

Home Street Address or P.O. Box:
City:
State/Province:
Zip/Postal Code:
Country:

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.

4.	In lieu of a signature, BNP Media requires a unique identifier used only for subscription verification purposes. What is your date of birth?

Your fax number is used to communicate to you. By providing your fax number, you are giving your written permission to receive subscription and other related information from BNP Media that may be of interest to you by fax. BNP Media will not share this information or use it for any other purpose. Would you like to receive subscription faxes sent by CircuiTree/BNP Media?

Yes No

6.	*Would you like to receive the CircuiTree* e-newsletter FREE of charge?**

Yes No

7.	What is your primary job function? (select only one)

Management Research & Development

Purchasing/Procurement Circuit Design

Manufacturing/Production Consultant

Process Engineering Professor/Instructor

Quality Control/Assurance Other (please specify)

Sales/Marketing

8.	What is your primary business? (select only one)

Printed Circuit Board Manufacturer Supplier to Fabricator (Equipment, Material, Services, etc.)

Electronic Manufacturing Services Other (please specify)

Original Equipment Manufacturer

9.	Please check the following as it applies to your company: (select only one)

Manufactures AND Assembles PCBs Only Assembles PCBs

Only Manufactures PCBs None of the above

10.

Please indicate if you influence the design, specification or purchase of the following: (select all that apply)

Fabrication Equipment PCBs

Fabrication Materials None of the above

Fabrication Services

11.

Please check the following items that your company manufactures: (select all that apply)

Multilayer PCBs Single-Sided PCBs

Flexible PCBs Assembled Boards

HDI Substrates None of the above

Double-Sided PCBs

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.