Healthcare Building Ideas Free Subscription

	*Healthcare Building Ideas* is free to qualified professionals. Summary Description
	To apply for a FREE subscription to *Healthcare Building Ideas*, 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, Canada

1.	*Do you wish to receive a FREE subscription to Healthcare Building Ideas?*

Yes No

First Name:
Last Name:
Job Title:
	(Ex: Director, Vice President, Project Manager, etc.)
Company:
	(Please provide your Company Name in full: abbreviations could disqualify you)
Company Website:
Address:
Dept/Mail Stop/Suite:
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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.

2.	Please Indicate the type of organization you work for: (select only one)

Healthcare Facility Consultant

Architect/Engineering Firm Supplier/Manufacturer

Contractor/Builder/Construction Other (please specify)

Design Firm

3.	Please indicate your primary job function: (select only one)

Corporate Management (Pres., CEO, Partner, Owner, CFO, etc.) Architectural/Engineering

Senior Management (VP, Director, Executive) Maintenance

Administration/Operations Purchasing

Construction Environmental

Facilities/Plant Management Safety/Security

Planning/Development Building/Grounds

Project Management Infection Control

Designer Other (please specify)

4.	In the performance of my job, I buy, specify and/or influence renovation or construction projects of healthcare facilities?

Yes No

5.	Please indicate the number of healthcare construction projects that your company will be involved in over the next 12 months: (select one for each)

Number of new healthcare sites to be constructed

10 or fewer

11-50

51-99

100 or more

Number of additions to be constructed

10 or fewer

11-50

51-99

100 or more

Number of sites to be renovated/remodeled

10 or fewer

11-50

51-99

100 or more

6.	How much does your organization plan to spend on renovate and/or new construction projects in the next 12 months? (select only one)

Up to $1,000,000 $10 Million - $24,999,999

$1 Million - $4,999,999 $25 Million - $100,000,000

$5 Million - $9,999,999 More than $100,000,000

7.	If you work in a healthcare facility, please indicate the number of beds that are at your location. (select only one)

0-50 251-500

51-100 501-1000

101-250 More than 1000

8.	In Lieu of a signature, we require a unique identifier used only for subscription purposes. What is the first letter of the city in which you were born?

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