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Contact Information
First Name:
Last Name:
Title:
Company Name:
Dept/Mail Stop:
Mailing Address:
City/Town:
State / Prov:
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Country (if not USA)
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Fax Number: (US Only)()-
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Is the above mailing address your home, business, both?
  Both
  Home
  Business
Tell us about your job

1. Please select the end products or services performed at this location. if this location is a

corporate/administrative/R&D office for manufacturing company.

 

 

PRIMARY End Product or Service  (Select Only One)

ALL End Products or Services  (Select All)

 

PRIMARY
End Product		ALL End
Products

 

Computers / Systems / Peripherals
Communication Systems
Industrial Controls
Test & Design Equipment
Medical Equipment
Automotive / Transportation and Equipment
Consumer Electronics / Appliances
Avionics / Government / Military Electronics
Design Services
Wireless
Other (Please Specify) 
2. What is your primary job function?
  Design & Development Engineering Management
  Research & Development Engineering Management
  Technical Management (CTO, CIO, System Architecht)
  Firmware / Software Engineering Management
  Design & Development Engineering
  Research & Development Engineering
  Test Engineering Staff
  Systems Engineer
  Hardware Engineer
  Firmware / Software Engineer
  Executive / Corporate / General Management
  Other(Please Specify) 
3. How many employees are in your entire organization? (including all divisions, branches and subsidiaries)
  20,000 or more
  10,000 - 19,999
  5,000 - 9,999
  1,000 - 4,999
  500 - 999
  100 - 499
  50 - 99
  less than 50

4. Would you like to receive relevant 3rd party offers about new products/services and discounted offers via email? please note: We value the privilege of contacting you via email, and never release your email. All emails are sent out using a bonded third party service bureau, and you are given the opportunity to opt-out of email correspondence with each email you receive. 

  YES
  NO