1.	Do you wish to receive a FREE subscription to Smart Meetings?

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First Name:
Last Name:
Title:
	(Ex: Director, Test Lead, Project Manager, etc.)
Company:
	(Please provide your Company Name in full: abbreviations could disqualify you)
Street Address:
Suite/Dept:
City:
State/Province:	Select for USA or Canada 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   Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory   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   Other
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What is the approximate number of employees in your company? (select only one)

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

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

2.	In lieu of a signature, we require a personal identifier. To verify that you submitted this request please enter below question: In what month were you born?

Select month born January February March April May June July August September October November December

3.	Do you plan meetings in Western US, Western Canada or Mexico?

Yes     No

4.	What is the primary business of your organization? (select only one)

Professional Independent Mtg/Convention Planner	Corporate cont.
Corporate	Government/Nonprofit
Manufacturing	Association
Medical/Pharmaceutical	Social/Military/Educational/Fraternal Assoc.
Finance/Insurance/Real Estate/Legal	Health/Medical Assoc.
Communications/Utility/Transportation	Religious Assoc.
Wholesale/Retail/Distribution	Business/Professional Assoc.
Computer/High Tech	Trade/Union/Labor Assoc.
Professional Services/Business Firms	Publishing/Media/Mktg/PR/Entertainment
Travel Agency/Incentive Travel	Other (please specify)
Education
Health Care

5.	Which best describes your job title? (select only one)

Meeting Planner	Marketing/Sales Manager
Chairman/CEO/Owner/President	Training/Education Manager
Executive VP/Director	Office Personnel/Other Manager
Convention/Conference Manager	Other (please specify)

6.	Your responsibilities include: (select all that apply)

Meeting/Conference Planner	Trade Shows/Exhibits/Conventions
Board/Management Meetings	Site Selection
Training/Education Meetings	None of the above
Incentive Travel

7.	Types of facilities you use: (select all that apply)

Downtown Hotel	Convention Center
Suburban Hotel	Cruise Ship/Boat Charter
Airport Hotel	Gaming Facility
Resort	Golf
Conference Center

8.	Number of meetings you plan annually? (select only one)

1	13-24
2	25-50
3-5	51-100
6-12	Over 100

9.	Seasons when your meetings are held: (select all that apply)

Spring	Winter
Summer	All Year long
Fall

10.	Meeting size: (select all that apply)

Over 1,000	100-249
500-999	Less than 100
250-499

11.	Where you hold or plan to hold meetings? (select all that apply)

WEST	EAST cont.
Alaska	New York
Arizona	North Carolina
California	Ohio
Colorado	Pennsylvania
Hawaii	Rhode Island
Idaho	South Carolina
Montana	Vermont
Mexico	Virginia
Western Canada	CENTRAL
New Mexico	Alabama
Oregon	Arkansas
Utah	Illinois
Washington	Indiana
Wyoming	Iowa
Canada	Kansas
Nevada	Kentucky
All States	Louisiana
EAST	Michigan
Connecticut	Wisconsin
Washington D.C.	Minnesota
Delaware	Mississippi
Florida	Missouri
Georgia	Oklahoma
Maine	North Dakota
Massachusetts	Nebraska
Maryland	South Dakota
New Hampshire	Tennessee
West Virginia	Texas
New Jersey

12.	Let us know your planning needs so we can serve you better: (select only one)

Immediate Need	Future Project
Next 6 Months

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