Restoration & Remediation Free Subscription

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

Yes No

2.	Please check your preferred format: (select only one)

Print Version of Restoration & Remediation (FREE) Digital Version of Restoration & Remediation (FREE)*

*All digital subscribers will receive the print version until digital is available.

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)
Business Address:
Dept/Mail Stop/Suite:
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.)
Phone:
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:
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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.

4.	In lieu of a signature, BNP Media requires a unique identifier used only for subscription verification purposes. How many letters are in your father's first name?

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. We will not share this information or use it for any other purpose. Would you like to receive subscription faxes sent by Restoration & Remediation/BNP Media?

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

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7.	Your primary business activity: (select only one)

Water Damage Restoration Property/Facility Management

Smoke/Fire Damage Restoration Laboratory Services

Mold Remediation Distributor

Indoor Environmental Professional Manufacturer's Rep/Sales Agent

Insurance Claims/Risk Management Other (please specify)

8.	Your primary job function: (select only one)

Owner/President Asset/Loss Management

General Management Sales

Restoration/Remediation Technician Other (please specify)

Project Manager

9.	Your purchasing authority: (select only one)

Approve/Purchase Recommend

Specify None of the above

10.

Your annual sales volume: (select only one)

More than $10,000,000 $500,001 - $1,000,000

$5,000,001 - $10,000,000 $250,001 - $500,000

$1,000,001 - $5,000,000 Up to $250,000

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You Specialize In: (select all that apply)

Your Primary Business/Industry:

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Your Job Title:

Please Specify for Other:

During Peak Season, Your Firm Employs the Following Number of People:

What is your company's primary field of work?

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* 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.