1.	Do you wish to receive a FREE subscription to Packaging World?

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

2.	What is the primary product packaged at your location or your company's primary packaged product? (select only one)

A. FOOD AND BEVERAGE PRODUCTS	B. HEALTHCARE/PERSONAL CARE/CHEMICAL (cont.)
Meat, Poultry, Seafood	Nutraceutical, Vitamin, Dietary Supplement
Fruits, Vegetables (Fresh, Canned Frozen)	Government
Grains, Seeds, Beans, Flour, Nuts	C. OTHER PACKAGED PRODUCTS
Cereals, Breakfast Foods	Apparel, Textiles
Baked Goods, Cookies, Crackers, Pasta, Snack Foods	Consumer Electronics, Computers, Peripherals, Household Appliances
Confectionary Products, Sugar	Toys, Games, Sporting Goods
Dairy Products	Plastic, Rubber Products
Beverages (Soft Drinks, Juices, Alcoholic Beverages, Coffee, Tea)	Paper, Printed Products, Office Supplies
Soups, Sauces, Condiments, Dressings, Spices, Syrup, Powders	Metal Glass, Wood Products
Fats, Oils	Machinery, Electronic
Pet Foods, Animal Foods	Other Packaged Products
Other Food and Beverage Products	Food Stores, Food Service
B. HEALTHCARE/PERSONAL CARE/CHEMICAL	Wholesalers, Distributors, Warehouses
Cosmetics, Toiletries, Baby Products	Contract Packager
Soap, Household Cleaners, Other Household Products	Package Design Firm
Chemicals, Paints, Adhesives	Packaging Machinery
Pharmaceutical	Other Products Or Services (please specify)
Medical Devices/Diagnostic Instruments

3.	Number of employees at this location? (select only one)

1 - 19	250 - 499
20 - 49	500 - 999
50 - 99	1000+
100 - 249

4.	I authorize, specify, recommend or approve for purchase the following packaging products: (select all that apply)

Materials/Containers	Controls/Related Components
Equipment/Machinery	None of the above
Packaging Service/Contract Packaging

5.	Does your company perform contract packaging or co-pack for other companies?

Yes     No

6.	Which of the following publications do you receive personally addressed to you by mail? (select all that apply)

Food & Drug Packaging	PMT
Packaging Digest	None of the above
Pharmaceutical and Medical Packaging News

7.	In lieu of a signature, we require a personal identifier. To verify that you submitted this application please specify the name of the high school you attended.

What is the name of the high school you attended?    

Would you like to receive EMAIL notices of other print or online publications, and other relevant offers from TradePub.com?

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Would you like to receive relevant information from TradePub.com on behalf of third party businesses/organizations?

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