FREE Subscription Application

If you have a Priority Code, please enter it here:
If you do not have a Priority Code, leave this field blank.

BUSINESS ADDRESS (Required)

  denotes a required field in this business address block.

First Name
Last Name
Title
Company
Street Address
Department/Mail Stop
City
State/Province	Select State/Province        Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam 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 Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming ---------------------------------------- U.S. Military - America (AA) U.S. Military - Overseas Europe (AE) U.S. Military - Overseas Pacific (AP) ---------------------------------------- ALBERTA BRITISH COLUMBIA MANITOBA NEW BRUNSWICK NEWFOUNDLAND NOVA SCOTIA NORTHWEST TERRITORIES NUNAVUT ONTARIO PRINCE EDWARD ISLAND QUEBEC SASKATCHEWAN YUKON TERRITORY ---------------------------------------- I am not in the U.S. or Canada
Country	Fill in this field only if you are not in the U.S. or Canada
Zip/Postal Code	USA/U.S. Military: Enter Zip +4 code without the hyphen (e.g. 123456789) CANADA: Enter postal code per usual (e.g. A1B 2C3) OTHER: Enter postal code per usual, if applicable
E-mail Address	Your subscription includes Automation World's e-mail newsletters that are relevant to the field of automation. You may unsubscribe from these at any time.
Business Phone
Business Fax	YES, I WISH TO RECEIVE RENEWAL FAXES International Subscribers: Enter Phone and Fax number without the hyphen or brackets (e.g. 123456789)

01 Packaging 02 Food/Beverage 03 Pharmaceutical 04 Chemical 05 Petroleum 06 Consulting/Integration 07 Utilities 08 Wood Products 09 Fabricated Metals 10 Pulp & Paper 11 Machinery

12 Automotive 13 Instrumentation and Control 14 Semiconductor 15 Computer & Electronics 16 Printing 17 Plastics & Rubber 18 Aerospace 19 Government & Military 20 Medical 21 Telecommunications 22 Water/Wastewater 98 Other (Please specify.)

01 VP/Manufacturing 02 Syst. Integrator/Consultant 03 CEO/President 04 General Manager 05 Chief Technology Officer 06 Chief Information Officer 07 IT Manager 08 Network Manager 09 VP Finance 10 Buyer

11 VP/Director Engineering 12 Automation/Control Engineer 13 VP Production/Planning 14 Plant Facilities Manager 15 Systems Design Engineer 16 Product Design Engineer 17 Quality Engineer 18 Production Engineer 19 Maintenance Engineer 20 Other Engineering 98 Other (Please specify.)

01 1000+	04 100 to 249
02 500 to 999	05 under 100
03 250 to 499

01Plan/approve automation project budgets

02Implement/integrate automation projects

03Operate/maintain/improve automation systems

99None of the above

Software 00 MES 01 ERP 02 Life Cycle Management 03 Planning & Scheduling 04 Network 05 Server 06 Historian 07 Analysis 08 HMI/SCADA 09 PLC 10 Motion Control 11 Adv. Process Control

Devices 12 Servers/Computers 13 Networks 14 Sensors 15 HMIs 16 PLC/Process Controllers 17 Actuators 18 Vision Systems 19 Robotics 20 Motion Control 21 Motors 22 Bar Code System

98		Other (Please specify.)
	99		None of the above.

Personal Identifier

Audit Verification (Required)
In lieu of a signature, we require a personal identifier. To verify that you submitted this application please specify the name of the high school you attended.

What is the name of the high school you attended?