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QUALIFICATION FORM

Incomplete forms will not be processed. A complimentary subscription to Government Video will be sent to those applicants who qualify. The publisher reserves the right to limit the number of subscriptions accepted.

1.	I wish to receive Government Video magazine FREE of charge.

Yes!

No

NOTE: In order to be considered for a subscription to Government Video, you MUST select Yes above. If you do not select Yes, you will not receive a complimentary subscription to Government Video.

2.	Would you like to receive your Government Video subscription in a digital format instead of print if it becomes available?

Yes

No

3.	Reader feedback is important to us. May a member of our Editorial Research team contact you via email?

Yes

No

4.	Would you like to receive exclusive articles and white papers from Government Video editors and partners in a digital, interactive format?

Yes

No

5.	Organization:

Dept of Defense (Military & Civilian personnel/Other defense funded entities)

Federal Government (FBI/CIA/Other Federally funded law enforcement entities, Research Executive/Judicial/Legislative Branches, Department of Labor, Transportation, IRS, Social Security, and Other federal funded entities)

State/County/City Governments (Law Enforcement Agencies, Fire Departments, Judiciary branches, and Other tax funded entities)

Prime Contractors/Integrators/Dealers/VAR's/Systems Designers & Installers

Manufacturer/Manfacturers Rep

Independent Teleproduction/Post Production/Duplication/Multimedia/Animation & Graphics House

Consulting Firms/Services

Other

6.	Job Description

Management/Command

Production/Post Production/Editor, Camera Person, Lighting, Audio and Other Creative Personnel

Engineering/Technical Support

Procurement/Purchasing

Presentation (Audio/Video/Audio Visual/Graphics) Training, Education, Multimedia

Other

7.	Major Application Area (check all that apply)

Video Production

Training and presentation

Broadcast/Cable/Satellite

CCTV/Surveillance/Security

Computer Graphics/Multimedia

Video Conferencing/Distance Learning

Medical/Scientific/Imaging/Research

Other

8.	Do you work in an in-house A/V production or video conferencing facility?

Yes

No

9.	Do you buy, specify or recommend products or services used in A/V, visual communications or imaging?

Yes

No

10.	What is the annual equipment and software budget for A/V and related products for your specific facility?

$500,000 or more

$250,000 to $499,999

$100,000 to $249,999

$25,000 to $99,000

$10,000 to $24,000

$9,999 or less

11.	Which of the following product categories will you be evaluating for purchase within the next 12 months? (check all that apply)

12.	What method do you use to purchase A/V related products and services? (check all that apply)

Open Market - Dealer or Reseller

GSA Schedule - Manufacture Direct

Open Market - Manufacture Direct

GSA Schedule - Dealer or Reseller

None of the above

13.	In lieu of a signature, Audit Bureau regulations require that we ask a validation question as proof of your request to subscribe. What day of the month were you born?

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