First Name: Last/Surname: Organization or Company: (put SELF if Consultant) E-mail Address: Country: United States Abidjan Argentina Antigua Australia Austria Bahrain Barbados Belgium Bermuda Bolivia Botswana Brazil Bulgaria Canada Chile China Colombia Côte d'Ivoire Croatia Cuba Curaçao Czech Republic Denmark Dominican Republic Egypt El Salvador Estonia Fiji Finland France Germany Ghana Greece Guatemala Hong Kong Hungary Iceland India Indonesia Iran Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Korea Kuwait Latvia Lebanon Luxembourg Malawi Malaysia Malta Mauritius Mexico Morocco Namibia Netherlands New Zealand Nigeria - NOT LISTED - Norway Pakistan Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Romania Russia Saipan Saudi Arabia Scotland Singapore Slovakia Slovenia South Africa Spain Sri Lanka Sweden Switzerland Taiwan Thailand Trinidad Turkey Ukraine United Arab Emirates United Kingdom Uruguay Venezuela Viet Nam West Africa Yugoslavia Zambia Zimbawe Org's Homepage Address: (put NA if you do not have a website) Type of Business: ACADEMIC (e-mail address must contain institution name) COMPANY (e-mail address must contain company name) GOVERNMENT AGENCY (e-mail address must contain agency name) CONSULTANCY (e-mail address must contain company name) NOT FOR PROFIT ORG (e-mail address must contain organization name) Industry: AEROSPACE AGRICULTURE AIRLINE APPAREL AUTOMOTIVE BEVERAGE BUSINESS SERVICES CHARITIES CHEMICAL COMMUNICATION COMPUTER CONSTRUCTION CONSUMER GOODS DEFENSE DEPARTMENT STORES DISTRIBUTION DURABLE GOODS EDUCATION ELECTRONIC ENTERTAINMENT ENVIRONMENT FINANCE FISHING FOOD FORESTRY FURNITURE HEALTH CARE HOSPITALITY INFORMATION INSURANCE INVESTMENT LEGAL LOCAL OR REGIONAL GOVERNMENT MANUFACTURING MACHINERY MEASUREMENT MEDIA MEDICAL SUPPLIES METAL MINING OFFICE EQUIPMENT OTHER PACKAGING PAPER PETROCHEMICAL PHARMACEUTICALS PHOTOGRAPHY PLASTICS REAL ESTATE RECYCLING RESEARCH RESTAURANT RETAIL SAFETY SERVICE SOFTWARE TEXTILE TRANSPORTATION TRAVEL UTILITIES WHOLESALE Referred By: Association or Industry Group (please indicate assoc/group below) Brochure Colleague or Friend (please indicate the name of person below) Conference or Seminar (please indicate the event host below) Email invitation (please indicate from who below) Intranet Link from another website (please indicate website below) Magazine / Journal article (please indicate publication below) Other (please provide details below) Postal Mailing Search Engine - Google Search Engine - Other (please specify below) Search Engine - Yahoo! Survey Invitation Referred By Details: Credit Card Information All funds are in $US dollars and secured by
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Group Access Code (Keycode) Your Group's KEYCODE is: 89146 In order to ensure that only the people you want to use your license get enrolled, enrollees will be required to supply a special KEYCODE when they enroll. This will enable you to control who gets to use one of your ten subscriptions. If somone enrolls and does not provide the KEYCODE or provides an invalid KEYCODE, their enrollment form will be rejected and discarded. It is up to you to communicate the KEYCODE of 89146 to the people you want to join on your Group License.
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