Direct Free Subscription

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

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First Name:
Last Name:
Job Title:
	(Ex: Director, Vice President, Project Manager, etc.)
Company Name:
	(Please provide your Company Name in full: abbreviations could disqualify you)
Department/Mail Stop:
Address:
City:
State :
Zip/Postal Code:
Country:
Business Phone:
Business Fax*:
Email Address**:
	(Note: Valid email address is required or you could be disqualified.)

*Your fax number is used to communicate to you. By providing your fax number, you are giving your written permission to receive subscription & other related information from Direct that may be of interest to you by fax. Penton Media will not share this information or use it for any other purpose. You may opt out of receiving faxes from them any time in the future.
**For a full statement of Penton Media's Subscriber Privacy Policy, visit their website at penton.com.

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

What is the approximate number of employees in your company? (select only one)

2.	In lieu of a signature, Penton Media requires a unique identifier used for subscription verification purposes by their auditing bureau. What is the month of your birth?

3.	Please check the one category that best describes your company: (select only one)

Advertising/Sales Promotion/Direct Marketing Agency or Consultant List Compiler/List Manager

Manufacturer (Excluding Hi-tech) Association/Fund Raising/Non-Profit Organization

Hi-tech: ISP, Computers, Telecommunications, Software Hospital/Health Care

Retailer Education/Seminars/Trade Shows

Instore Social Services

Mail Order Public Administration/Government

Instore and Mail Order Communication/Transportation/Utility

Electronic Banking/Insurance/Real Estate/Financial

Wholesaler/Distributor Entertainment/Hospitality/Travel

Publisher (Books, Magazines, Newspapers, Music or Video) Services (Consumer or Business) - (please specify)

List Broker

4.	My primary job function is: (select only one)

Corporate/General Management Fulfillment/Data Processing Management

Sales/Marketing/Telemarketing Management Mailroom/Operations Management

Advertising/Promotion Management Production/Creative Management

Circulation/List/Media Management Other (please specify)

5.	Which of the following types of media are used by your company and/or clients? (select all that apply)

Solo Mailings Publishing Media

Catalogs/Multi-Page Mailers Telemarketing

Free Standing Inserts/Coupons DRTV/Radio

Card Decks Electronic Commerce

Package/Co-ops Inserts

6.	I am involved with: (select only one)

Consumer Direct Marketing Both Consumer and Business to Business

Business to Business Direct Marketing

7.	Please check the approximate annual total direct marketing expenditures for your company and/or clients: (select only one)

Over $10 million $500,000 - $1 million

$5 million - $10 million Under $500,000

$1 million - $5 million

8.	I specify, recommend, approve, purchase or influence the purchase of: (select all that apply)

Database Marketing Services Distribution Services

Telemarketing Services Fulfillment Services

List/Related Services Sales Promotion

Printing/Related Services Financial Products/Services

E-Commerce Services Desktop Publishing Systems/Services

Paper Search Engine Marketing/Optimization

International Direct Marketing Services Equipment (please specify)

Lettershops/Mailing Services

9.	*If Direct* launches a digital edition in the future, would you like to receive your issues in this format rather than print?**

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10.

Please select the following newsletters that you would like to receive:

Do you wish to receive Direct Newsline free via email?
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Do you wish to receive Direct ListLine free via email?
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What best matches the number of employees in your business? (select only one)

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