International Hospital Equipment & Solutions Free Subscription

	*International Hospital Equipment & Solutions* is free to qualified healthcare professionals. Summary Description
	To apply for a FREE subscription to *International Hospital Equipment & Solutions*, 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: Mexico, Selected International

1.	*Do you wish to receive a FREE subscription to International Hospital Equipment & Solutions?*

Yes No

First Name:
Last Name:
Job Title:
Hospital/Institution:
	(Please provide your Hospital/Institution Name in full: abbreviations could disqualify you)
Company Name:
	(Please provide your Company Name in full: abbreviations could disqualify you)
Department:
Street:
Address 1:
Address 2:
City:
State/Province:
Zip Code/Postal Code:
Country:
	(Note: If your country is not listed above, distribution is not currently available at your location.)
Phone:
Fax:
Email Address:
	(Note: Valid personal email address is required or you could be disqualified.)

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

Which of the following best describes your industry? (select only one)

Please specify for Other:

Which of the following is closest to your job function? (select only one)

Please specify for Other:

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

Subscriber data collected in the registration process by PanGlobal Media, the publisher of IHE, may be used for selecting information on relevant products and services of carefully screened third parties. If you would like to receive such information by email please tick the box below.

Yes, I would like to receive email information on relevant products and services from third parties.

Otherwise, your email address will only be used in connection with this subscription and will not be made available to any third parties.

2.	Which format would you prefer to receive: (select only one)

Print Digital

3.	What is your principal job? (select only one)

Hospital Administrator/Hospital Director Non Hospital/Healthcare Function (e.g. Distributor)

Medical Department Head Other incl. Non Hospital based Physicians (please specify)

Medical Practitioner

Central Services Staff

4.	What is your specialty/department? (select only one)

Hospital Administration & General Staff including Hospital IT and Biomedical Engineering Physiotherapy/Rehabilitation

Radiologist & Medical Imaging Specialists Other Medical Specialists - Neurology, Ophthalmology, Otolaryngology (please specify)

Anaesthesiology & Intensive Care

Cardiology & Internal Medicine Non Hospital/Healthcare (please specify)

Surgery/Gynaecology/Urology

5.	Please indicate the total number of beds in your hospital/institution. (select only one)

Up to 150 beds Over 1000 beds

from 151 to 500 beds no beds (not a hospital/Clinic)

from 501 to 1000 beds

6.	Please indicate the type of institution. (select only one)

Hospital/Clinic/University Hospital Hospital Planner/Turnkey Contractor/Procurement

Outpatient Clinic/Medical Centre Distributor of Medical Products

Rehabilitation Clinic/Nursing Home/Extended Care Other (please specify)

Government Authority/Health Agency

7.	In order to verify your request you must supply a unique identifier (This question is for circulation audit purposes only). What is your month of birth?

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 personal 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.