Complete and verifiable information is required in order to qualify for this Magazine.

First Name: Last Name:   Job Title:   Company Name:   Business Email: Phone: Fax:

Division/Mail Stop: Street Address: City: State/Province: Select for USA, Canada, or Mexico Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming American Samoa Guam Marshall Islands Micronesia (Federated States of) Palau Puerto Rico U.S. Minor Outlying Islands U.S. Virgin Islands Northern Mariana Islands Armed Forces Americas AA Armed Forces Middle East, Europe, Canada AE Armed Forces Pacific AP Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory Aguascalientes Baja California Baja California Sur Campeche Coahuila Colima Chiapas Chihuahua Distrito Federal Durango Guanajuato Guerrero Hidalgo Jalisco Michoacan Morelos Nayarit Nuevo Leon Oaxaca Puebla Queretaro Quintana Roo San Luis Potosi Sinaloa Sonora Tabasco Tamaulipas Tlaxcala Veracruz Yucatan Zacatecas Other Postal/ZIP Code: Country: Select Country UNITED STATES CANADA INDIA UNITED KINGDOM == AFGHANISTAN ALBANIA ALGERIA AMERICAN SAMOA ANDORRA ANGOLA ANGUILLA ANTARCTICA ANTIGUA AND BARBUDA ARGENTINA ARMENIA ARUBA AUSTRALIA AUSTRIA AZERBAIJAN AZORES BAHAMAS BAHRAIN BANGLADESH BARBADOS BELARUS BELGIUM BELIZE BENIN BERMUDA BHUTAN BOLIVIA BOSNIA AND HERZEGOVINA BOTSWANA BR VIRGIN ISLAND BRAZIL BRITISH INDIAN OCEAN TERRITORY BRUNEI BULGARIA BURKINA FASO BURUNDI CAMBODIA CAMEROON CANARY ISLANDS CAPE VERDE CAYMAN ISLANDS CENTRAL AFRICAN REP CHAD CHANNEL ISLANDS CHILE CHINA, PEO REPBL CHRISTMAS ISLAND COCOS (KEELING) ISLANDS COLOMBIA COMOROS CONGO CONGO, THE DEMOCRATIC REPUBLIC OF THE COOK ISLANDS COSTA RICA COTE D'IVOIRE CROATIA CUBA CYPRUS CZECH REPUBLIC DENMARK DJIBOUTI DOMINICA DOMINICAN REPUBLIC ECUADOR EGYPT EL SALVADOR ELAND ISLANDS EQUATORIAL GUINEA ERITREA ESTONIA ETHIOPIA FALKLAND ISLANDS FAROE ISLANDS FIJI FINLAND FRANCE FRENCH GUINEA FRENCH POLYNESIA GABON, REPUBLIC OF GAMBIA GEORGIA GERMANY GHANA GIBRALTAR GREECE GREENLAND GRENADA GUADELOUPE GUAM GUATEMALA GUERNSEY GUINEA BIASSAU GUINEA,REPUBLIC OF GUYANA HAITI HONDURAS HONG KONG HUNGARY ICELAND INDONESIA IRAN IRAQ IRELAND ISRAEL ITALY JAMAICA JAPAN JORDAN KAZAKHSTAN KENYA KOREA,DEMOCRATIC REPUBLIC OF KOREA,REPUBLIC OF KOSOVO KUWAIT KYRGZSTAN LAOS LATVIA LEBANON LESOTHO LIBERIA LIBYA LIECHTENSTEIN LITHUANIA LUXEMBOURG MACAU MACEDONIA MADAGASCAR MADEIRA MALAWI MALAYSIA MALDIVES MALI MALTA MARSHALL ISLANDS MARTINIQUE MAURITANIA MAURITIUS MAYOTTE MEXICO MICRONESIA MOLDOVA MONACO MONGOLIA MONTENEGRO MONTSERRAT MOROCCO MOZAMBIQUE NAMIBIA NAURU ISLANDS NEPAL NETHERLANDS ANTILLES NETHERLANDS NEW CALEDONIA NEW ZEALAND NICARAGUA NIGER NIGERIA NORFOLK ISLAND NORTHERN MARIANA ISLANDS NORWAY OMAN PAKISTAN PALAU PALESTINIAN TERRITORY, OCCUPIED PANAMA PAPUA NEW GUINEA PARAGUAY PERU PHILIPPINES POLAND PORTUGAL QATAR REPUBLIC OF KIRIBATI REUNION ROMANIA RUSSIAN FED RWANDA SAINT PIERRE AND MIQUELON SAMOA SAN MARINO SAO TOME AND PRINCIPE SAUDI ARABIA SENEGAL SERBIA SEYCHELLES SIERRA LEONE SINGAPORE SLOVAKIA SLOVENIA SOCIETY ISLANDS SOLOMON ISLANDS SOMALIA,REPUBLIC SOUTH AFRICA SPAIN SRI LANKA ST KITTS ST LUCIA ST VINCENT SUDAN SURINAM SWAZILAND SWEDEN SWITZERLAND SYRIA TAHITI TAIWAN TAJIKISTAN TANZANIA THAILAND TIMOR-LESTE TOGO TONGA TRINIDAD AND TOBAGO TUNISIA TURKEY TURKMENISTAN TURKS AND CAICOS ISLANDS TUVALU UGANDA UKRAINE UNION OF MYANMAR UNITED ARAB EMIRATE UNITED KINGDOM,ENGLAND UNITED KINGDOM,NO.IRELAND UNITED KINGDOM,SCOTLAND UNITED KINGDOM,WALES URUGUAY UZBEKISTAN VANUATU VATICAN CITY VENEZUELA VIETNAM, RPBLC OF VIRGIN ISLANDS, U.S. WALLIS AND FUTUNA WESTERN SAHARA WESTERN SAMOA YEMEN ZAMBIA ZANZIBAR ZIMBABWE OTHER

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

Your offer confirmation will be sent to your business email address entered above.

What is the approximate number of employees in your company?

Select Number of Employees Less than 50 50 - 99 100 - 499 500 - 999 1,000 - 4,999 5,000 - 9,999 10,000 - 19,999 20,000 +

---

1.

Do you wish to receive a FREE subscription to AV Technology?

Yes     No

2.

Which version of AV Technology do you wish to receive?

Print     Digital

3.

You will receive subscription notifications via email. Do you wish to receive other Email and other promotions from NewBay Media LLC?

Yes     No

4.

Would you like to receive Email and/or promotions from trusted NewBay Media LLC marketing partners?

Yes     No

5.

Reader feedback is important to NewBay Media LLC. May a member of their Editorial Research team contact you via email?

Yes     No

6.

Would you like to receive exclusive articles and white papers from AV Technology's editors and partners in a digital, interactive format?

Yes     No

7.

Nature of Business:

Select business Corporate K-12 University/College Federal Government State Government Local Government Financial Services Healthcare Legal Professional Worship Entertainment/Hospitality Restaurants Casinos/Gaming Retail Rental and Staging Stadiums/Arenas/Performing Arts Centers Transportation Other Please Specify for Other:

8.

Job Title:

	Select job title AV Manager IT Manager/IT Director HR & Training Manager/Instructional Manager/Curriculum Manager Superintendent/Chief Administrator Facility Planner and Manager Manager of MIS and Communications CEO, Executive Marketing/Sales Event Producer AV Integrator AV Design Consultant Music Manager Other
	Please Specify for Other:

9.

Which statement best describes your role in hiring or purchasing AV and/or IT equipment, products or services?

Select role Approve/Authorize Initiate Request Research Products/Services/ Technology Specify Products/Services None of the Above

10.

Which associations do you belong to? (select all that apply)

	Infocomm	Educause
	NSCA	The Consortium for School Networking
	Association of Briefing Program Managers	Hospitality Financial and Technology Professionals
	International Facilities Managers	Telecommunications Industry Association (TIA)
	Media Communications Associations International	International Association of Assembly Managers (IAAM)
	IT Compliance Institute	BICSI
	Consortium of College and University Media Centers

11.

Annual AV / IT Budget:

Select budget $10,000 - $49,000 $50,000 - $149,000 $150,000 - $999,000 $1 Million - $5 Million Above $5 Million

12.

Which products do you currently plan or intend to purchase? (select all that apply)

	AV Services	Mounting Systems
	Acoustics and Audio	Power Management
	Audio equipment and Video Conferencing Equipment	Presentation and Training Aids
	Audio Production and Recording	Projection Screens
	Cables Connectors and Accessories	Projectors, Lamps, and Accessories
	Camera/Camcorders - Related Products	Racks and Rackmount Systems
	Cameras/Camcorders	Recorders, Players and Duplication
	Cases and Bags	Recording Media and Storage Systems
	Computers and Software	Signal Management and Processing
	Control Systems	Streaming Media and Webcasting
	Digital Signage	Telephony, Data Communications
	Displays and Monitors (Plasma and LCD etc.)	Test and Measurement Equipment
	Document Cameras and Digital Imaging	Video Editing and Production
	Furniture and Consoles	Whiteboards, Markerboards, and Easels
	Lighting and Studio Support	Wireless Signal Systems and Equipment

13.

In lieu of a signature, Audit Bureau regulations require that they ask a validation question as proof of your request to subscribe. What is your state of birth?

Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Other

---

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